Provider Demographics
NPI:1215212535
Name:MISSAKIAN CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:MISSAKIAN CHIROPRACTIC, INC.
Other - Org Name:MISSAKIAN SPINE CARE CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MASSEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MISSAKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:559-781-3033
Mailing Address - Street 1:83 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3711
Mailing Address - Country:US
Mailing Address - Phone:559-781-3033
Mailing Address - Fax:559-781-3073
Practice Address - Street 1:83 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3711
Practice Address - Country:US
Practice Address - Phone:559-781-3033
Practice Address - Fax:559-781-3073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29768111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADM696AOtherMEDICARE PROVIDER NUMBER