Provider Demographics
NPI:1376802975
Name:EDDY CHIROPRACTIC
Entity Type:Organization
Organization Name:EDDY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:D
Authorized Official - Last Name:EDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:661-252-5192
Mailing Address - Street 1:19038 SOLEDAD CANYON RD.
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-3362
Mailing Address - Country:US
Mailing Address - Phone:661-252-5192
Mailing Address - Fax:661-252-5193
Practice Address - Street 1:19038 SOLEDAD CANYON RD
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-3362
Practice Address - Country:US
Practice Address - Phone:661-252-5192
Practice Address - Fax:661-252-5193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty