Provider Demographics
NPI:1043776172
Name:KINGDOM CHIROPRACTIC
Entity Type:Organization
Organization Name:KINGDOM CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:FEITSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-314-7172
Mailing Address - Street 1:7509 MADISON AVE UNIT 11
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7467
Mailing Address - Country:US
Mailing Address - Phone:916-314-7172
Mailing Address - Fax:
Practice Address - Street 1:7509 MADISON AVE UNIT 11
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7467
Practice Address - Country:US
Practice Address - Phone:916-314-7172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty