Provider Demographics
NPI:1073698759
Name:NEELEY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:NEELEY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KORBY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-475-8050
Mailing Address - Street 1:12925 EL CAMINO REAL
Mailing Address - Street 2:SUITE J24
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-1893
Mailing Address - Country:US
Mailing Address - Phone:858-755-0808
Mailing Address - Fax:858-755-7290
Practice Address - Street 1:12925 EL CAMINO REAL
Practice Address - Street 2:SUITE J24
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-1893
Practice Address - Country:US
Practice Address - Phone:858-755-0808
Practice Address - Fax:858-755-7290
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEELEY CHIROPRACTIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
CADC22098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ66071ZOtherBLUE SHIELD CHIROGROUP #
CAZZZ66072ZOtherBLUE SHIELD PT GROUP #
CAU43411Medicare UPIN
CAZZZ66071ZOtherBLUE SHIELD CHIROGROUP #
CAW19042Medicare PIN