Provider Demographics
NPI:1164479713
Name:PB CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:PB CHIROPRACTIC INC.
Other - Org Name:GRAND AVENUE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:PINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:858-273-1721
Mailing Address - Street 1:910 GRAND AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4046
Mailing Address - Country:US
Mailing Address - Phone:858-273-1721
Mailing Address - Fax:858-273-3207
Practice Address - Street 1:910 GRAND AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4046
Practice Address - Country:US
Practice Address - Phone:858-273-1721
Practice Address - Fax:858-273-3207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27356111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty