Provider Demographics
NPI:1275032534
Name:DOGWOOD BODYWORK & PERFORMANCE A CHRISTINA MULLEN CHIROPRACTIC CORP
Entity Type:Organization
Organization Name:DOGWOOD BODYWORK & PERFORMANCE A CHRISTINA MULLEN CHIROPRACTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:510-985-9096
Mailing Address - Street 1:5875 DOYLE ST STE 118
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2509
Mailing Address - Country:US
Mailing Address - Phone:510-985-9096
Mailing Address - Fax:510-295-2883
Practice Address - Street 1:5875 DOYLE ST STE 118
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-2509
Practice Address - Country:US
Practice Address - Phone:510-985-9096
Practice Address - Fax:510-295-2883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4102111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty