Provider Demographics
NPI:1104183201
Name:AMERICAN CHIROPRACTIC WELLNESS CENTER
Entity Type:Organization
Organization Name:AMERICAN CHIROPRACTIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:LIPSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-371-6144
Mailing Address - Street 1:1325 E. THOUSAND OAKS BLVD #104
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362
Mailing Address - Country:US
Mailing Address - Phone:805-371-6144
Mailing Address - Fax:805-371-6148
Practice Address - Street 1:1325 E. THOUSAND OAKS BLVD #104
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362
Practice Address - Country:US
Practice Address - Phone:805-371-6144
Practice Address - Fax:805-371-6148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-13
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27804305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization