Provider Demographics
NPI:1003006404
Name:EBADAT CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:EBADAT CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ASGHAR
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:EBADAT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-446-8444
Mailing Address - Street 1:PO BOX 26890
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95159-6890
Mailing Address - Country:US
Mailing Address - Phone:408-839-7814
Mailing Address - Fax:
Practice Address - Street 1:20445 PROSPECT RD STE 1
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-4663
Practice Address - Country:US
Practice Address - Phone:408-446-8444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23643111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ23836ZMedicare PIN