Provider Demographics
NPI:1003903410
Name:CHAMBERS, IAN (DC)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 POTRERO ST STE 52
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-2760
Mailing Address - Country:US
Mailing Address - Phone:831-466-3900
Mailing Address - Fax:831-466-3919
Practice Address - Street 1:303 POTRERO ST STE 52
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2760
Practice Address - Country:US
Practice Address - Phone:831-466-3900
Practice Address - Fax:831-466-3919
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 26273111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor