Provider Demographics
NPI:1356469464
Name:PELLICANI CHIROPRACTIC CORP
Entity Type:Organization
Organization Name:PELLICANI CHIROPRACTIC CORP
Other - Org Name:NECK AND BACK CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GITI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOKHBER PELLICANI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-378-2225
Mailing Address - Street 1:430 MARATHON DR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0918
Mailing Address - Country:US
Mailing Address - Phone:408-378-2225
Mailing Address - Fax:408-370-6653
Practice Address - Street 1:430 MARATHON DR
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0918
Practice Address - Country:US
Practice Address - Phone:408-378-2225
Practice Address - Fax:408-370-6653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16755111N00000X
CADC26233111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty