Provider Demographics
NPI:1033376975
Name:DOROTHY PONTON
Entity Type:Organization
Organization Name:DOROTHY PONTON
Other - Org Name:SAMARITAN HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PONTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-377-9555
Mailing Address - Street 1:3151 OLIN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1635
Mailing Address - Country:US
Mailing Address - Phone:408-377-9555
Mailing Address - Fax:
Practice Address - Street 1:3151 OLIN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1635
Practice Address - Country:US
Practice Address - Phone:408-377-9555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26475111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty