Provider Demographics
NPI:1275022576
Name:ACC GORNEY-TUTAK CHIROPRACTIC INC
Entity Type:Organization
Organization Name:ACC GORNEY-TUTAK CHIROPRACTIC INC
Other - Org Name:ADVANCED CHIROPRACTIC CENTERS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:GORNEY-TUTAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:530-615-4041
Mailing Address - Street 1:1061 E MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5724
Mailing Address - Country:US
Mailing Address - Phone:530-615-4041
Mailing Address - Fax:530-615-4043
Practice Address - Street 1:1061 E MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5724
Practice Address - Country:US
Practice Address - Phone:530-615-4041
Practice Address - Fax:530-615-4043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18807111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC18807OtherLICENSED DOCTOR OF CHIROPRACTIC