Provider Demographics
NPI:1154081693
Name:AMBER LYNNE LATZA CHIROPRACTIC AND SPORTS HEALTH, INC.
Entity Type:Organization
Organization Name:AMBER LYNNE LATZA CHIROPRACTIC AND SPORTS HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:LATZA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-878-1311
Mailing Address - Street 1:4725 1ST ST STE 264
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-7489
Mailing Address - Country:US
Mailing Address - Phone:925-425-7135
Mailing Address - Fax:
Practice Address - Street 1:4725 1ST ST STE 264
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-7489
Practice Address - Country:US
Practice Address - Phone:925-425-7135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-24
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty