Provider Demographics
NPI:1093890691
Name:BAZIL, RODERICK J (DC)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:J
Last Name:BAZIL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18800 MAIN ST
Mailing Address - Street 2:SUITE # 207
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1707
Mailing Address - Country:US
Mailing Address - Phone:714-375-5864
Mailing Address - Fax:714-375-4374
Practice Address - Street 1:18800 MAIN ST
Practice Address - Street 2:SUITE # 207
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1707
Practice Address - Country:US
Practice Address - Phone:714-375-5864
Practice Address - Fax:714-375-4374
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19377111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT82732Medicare UPIN
CADC19377Medicare ID - Type Unspecified