Provider Demographics
NPI:1346590254
Name:COSH CHIRPRACTIC CARE, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:COSH CHIRPRACTIC CARE, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DOCTOR, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:COSH
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:530-244-1185
Mailing Address - Street 1:2007 PINE ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1919
Mailing Address - Country:US
Mailing Address - Phone:530-244-1185
Mailing Address - Fax:530-244-1186
Practice Address - Street 1:2007 PINE ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1919
Practice Address - Country:US
Practice Address - Phone:530-244-1185
Practice Address - Fax:530-244-1186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25681261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU72061Medicare UPIN
CADC0256810Medicare PIN