Provider Demographics
NPI:1073643888
Name:ANTONIO SOTO JR DC CHIROPRACTIC PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ANTONIO SOTO JR DC CHIROPRACTIC PROFESSIONAL CORPORATION
Other - Org Name:SOTO CHIROPRACTIC INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:209-474-8215
Mailing Address - Street 1:1212 WEST ROBINHOOD DRIVE
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207
Mailing Address - Country:US
Mailing Address - Phone:209-474-8215
Mailing Address - Fax:209-474-8953
Practice Address - Street 1:1212 WEST ROBINHOOD DRIVE
Practice Address - Street 2:SUITE 1F
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207
Practice Address - Country:US
Practice Address - Phone:209-474-8215
Practice Address - Fax:209-474-8953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC13684111N00000X
CADC21575111N00000X
CADC28941111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID NUMBER
CADC0289410Medicare PIN
CAV02767Medicare UPIN
CADC0215750Medicare PIN
CA=========OtherTAX ID NUMBER
CAV02768Medicare UPIN
CAT05101Medicare UPIN
CAZZZ31932ZMedicare PIN