Provider Demographics
NPI:1275873200
Name:MOBILIZE
Entity Type:Organization
Organization Name:MOBILIZE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:415-298-1053
Mailing Address - Street 1:425 DIVISADERO ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-2242
Mailing Address - Country:US
Mailing Address - Phone:415-298-1053
Mailing Address - Fax:
Practice Address - Street 1:425 DIVISADERO ST
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-2242
Practice Address - Country:US
Practice Address - Phone:415-298-1053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32295111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty