Provider Demographics
NPI:1376231951
Name:ENVISTA MEDICAL NECK AND BACK CENTER, P.C.
Entity Type:Organization
Organization Name:ENVISTA MEDICAL NECK AND BACK CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-587-0700
Mailing Address - Street 1:3900 COFFEE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-5050
Mailing Address - Country:US
Mailing Address - Phone:661-587-0700
Mailing Address - Fax:
Practice Address - Street 1:4029 WESTERLY PL
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2318
Practice Address - Country:US
Practice Address - Phone:661-587-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENVISTA MEDICAL NECK & BACK CENTER, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy