Provider Demographics
NPI:1275866634
Name:TOTAL HEALTH CHIROPRACTIC
Entity Type:Organization
Organization Name:TOTAL HEALTH CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:TSURUMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:510-559-9555
Mailing Address - Street 1:10533 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-2890
Mailing Address - Country:US
Mailing Address - Phone:510-559-9555
Mailing Address - Fax:510-559-9522
Practice Address - Street 1:10533 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-2890
Practice Address - Country:US
Practice Address - Phone:510-559-9555
Practice Address - Fax:510-559-9522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25190111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0251900Medicare PIN