Provider Demographics
NPI:1114363413
Name:EVOKE SPINAL CARE
Entity Type:Organization
Organization Name:EVOKE SPINAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIETZEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:925-523-1022
Mailing Address - Street 1:391 TAYLOR BLVD
Mailing Address - Street 2:STE 130
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2257
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:391 TAYLOR BLVD
Practice Address - Street 2:STE 130
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2257
Practice Address - Country:US
Practice Address - Phone:925-523-1022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32227111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty