Provider Demographics
NPI:1164729760
Name:HARBOR BAY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:HARBOR BAY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBALL
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:510-521-6211
Mailing Address - Street 1:1151 HARBOR BAY PKWY
Mailing Address - Street 2:SUITE 127
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94502-6540
Mailing Address - Country:US
Mailing Address - Phone:510-521-6211
Mailing Address - Fax:510-521-6214
Practice Address - Street 1:1151 HARBOR BAY PKWY
Practice Address - Street 2:SUITE 127
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94502-6540
Practice Address - Country:US
Practice Address - Phone:510-521-6211
Practice Address - Fax:510-521-6214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17346261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT06447Medicare UPIN