Provider Demographics
NPI:1013178219
Name:DILLIARD CHIROPRACTIC PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DILLIARD CHIROPRACTIC PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:DILLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-447-2651
Mailing Address - Street 1:531 N MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-3608
Mailing Address - Country:US
Mailing Address - Phone:619-447-2651
Mailing Address - Fax:619-447-2493
Practice Address - Street 1:531 N MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3608
Practice Address - Country:US
Practice Address - Phone:619-447-2651
Practice Address - Fax:619-447-2493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ50212ZOtherBLUE SHIELD PROVIDER IDENTIFICATION NUMBER