Provider Demographics
NPI:1316008634
Name:FALKENROTH CHIROPRACTIC INC
Entity Type:Organization
Organization Name:FALKENROTH CHIROPRACTIC INC
Other - Org Name:FIVE STAR CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FALKENROTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:831-475-8600
Mailing Address - Street 1:11022 WINNERS CIR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2883
Mailing Address - Country:US
Mailing Address - Phone:562-430-9479
Mailing Address - Fax:562-430-9473
Practice Address - Street 1:2959 PARK AVE STE F
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2863
Practice Address - Country:US
Practice Address - Phone:831-475-8600
Practice Address - Fax:831-475-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25861111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1992800833OtherINDIVIDUAL NPI NUMBER
CADC25861OtherSTATE LICENSE NUMBER
CAZZZ64963ZOtherBLUE SHIELD ID#
CADC0258610Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID#