Provider Demographics
NPI:1326212028
Name:NEWBOLD CHIROPRACTIC APC
Entity Type:Organization
Organization Name:NEWBOLD CHIROPRACTIC APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEWBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:650-726-3300
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:EL GRANADA
Mailing Address - State:CA
Mailing Address - Zip Code:94018-0327
Mailing Address - Country:US
Mailing Address - Phone:650-726-3300
Mailing Address - Fax:650-726-3388
Practice Address - Street 1:455 AVENIDA ALHAMBRA
Practice Address - Street 2:
Practice Address - City:EL GRANADA
Practice Address - State:CA
Practice Address - Zip Code:94018
Practice Address - Country:US
Practice Address - Phone:650-726-3300
Practice Address - Fax:650-726-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0153330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0153330OtherPROVIDER NUMBER
CAT05719Medicare UPIN