Provider Demographics
NPI:1194819953
Name:FLETCHER CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:FLETCHER CHIROPRACTIC, INC
Other - Org Name:CALISTOGA CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:707-942-9592
Mailing Address - Street 1:1227 LINCOLN AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CALISTOGA
Mailing Address - State:CA
Mailing Address - Zip Code:94515
Mailing Address - Country:US
Mailing Address - Phone:707-942-9592
Mailing Address - Fax:707-942-9593
Practice Address - Street 1:1227 LINCOLN AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:CALISTOGA
Practice Address - State:CA
Practice Address - Zip Code:94515
Practice Address - Country:US
Practice Address - Phone:707-942-9592
Practice Address - Fax:707-942-9593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25138111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0251381Medicare ID - Type Unspecified
CAU69815Medicare UPIN