Provider Demographics
NPI:1225296742
Name:WORRALL CHIROPRACTIC INTERNATIONAL INC
Entity Type:Organization
Organization Name:WORRALL CHIROPRACTIC INTERNATIONAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:WORRALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:925-943-2222
Mailing Address - Street 1:15550 ROCKFIELD BLVD
Mailing Address - Street 2:B220
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2720
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:1610 OAK PARK BLVD
Practice Address - Street 2:2
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4489
Practice Address - Country:US
Practice Address - Phone:925-943-2222
Practice Address - Fax:925-943-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29929111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0299290OtherBLUE SHIELD
CADC0299290Medicare PIN
CAV07702Medicare UPIN