Provider Demographics
NPI:1033557889
Name:NORCAL INTEGRATED MEDICAL CORP
Entity Type:Organization
Organization Name:NORCAL INTEGRATED MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGOMARSINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-952-8851
Mailing Address - Street 1:4719 QUAIL LAKES DR # G-335
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5267
Mailing Address - Country:US
Mailing Address - Phone:209-952-8851
Mailing Address - Fax:
Practice Address - Street 1:5637 N PERSHING AVE STE F1
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-4943
Practice Address - Country:US
Practice Address - Phone:209-952-8851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 27930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty