Provider Demographics
NPI: | 1013357821 |
---|---|
Name: | AMBROSE CHIROPRACTIC INC. |
Entity Type: | Organization |
Organization Name: | AMBROSE CHIROPRACTIC INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JOSEPH |
Authorized Official - Middle Name: | R |
Authorized Official - Last Name: | AMBROSE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 916-933-6700 |
Mailing Address - Street 1: | 350 GREEN VALLEY RD |
Mailing Address - Street 2: | |
Mailing Address - City: | EL DORADO HILLS |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 95762-3927 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 916-933-6700 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 350 GREEN VALLEY RD |
Practice Address - Street 2: | |
Practice Address - City: | EL DORADO HILLS |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95762-3927 |
Practice Address - Country: | US |
Practice Address - Phone: | 916-933-6700 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-06-26 |
Last Update Date: | 2013-06-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | DC18301 | 111NN0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111NN0400X | Chiropractic Providers | Chiropractor | Neurology | Group - Single Specialty |