Provider Demographics
NPI:1003181348
Name:ERIC J STORM & BRENDA J REID
Entity Type:Organization
Organization Name:ERIC J STORM & BRENDA J REID
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JON
Authorized Official - Last Name:STORM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-949-3969
Mailing Address - Street 1:16727 BEAR VALLEY RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-1897
Mailing Address - Country:US
Mailing Address - Phone:760-949-3969
Mailing Address - Fax:760-949-0697
Practice Address - Street 1:16727 BEAR VALLEY RD
Practice Address - Street 2:SUITE 260
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1897
Practice Address - Country:US
Practice Address - Phone:760-949-3969
Practice Address - Fax:760-949-0697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0164920Medicare UPIN
CADC0160720Medicare UPIN