Provider Demographics
NPI:1174654370
Name:SOLEDAD CANYON CHIROPRACTIC-FITZPATRICK, INC.
Entity Type:Organization
Organization Name:SOLEDAD CANYON CHIROPRACTIC-FITZPATRICK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:661-251-9004
Mailing Address - Street 1:19004 SOLEDAD CANYON ROAD
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-3362
Mailing Address - Country:US
Mailing Address - Phone:661-251-9004
Mailing Address - Fax:661-251-9270
Practice Address - Street 1:19004 SOLEDAD CANYON ROAD
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-3362
Practice Address - Country:US
Practice Address - Phone:661-251-9004
Practice Address - Fax:661-251-9270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23805111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty