Provider Demographics
NPI:1376894766
Name:BELLINGER CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:BELLINGER CHIROPRACTIC CORPORATION
Other - Org Name:GRACE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-445-8080
Mailing Address - Street 1:1775 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1338
Mailing Address - Country:US
Mailing Address - Phone:707-445-8080
Mailing Address - Fax:707-445-8088
Practice Address - Street 1:1775 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1338
Practice Address - Country:US
Practice Address - Phone:707-445-8080
Practice Address - Fax:707-445-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA357303900OtherFEFERAL WORKERS' COMPENSATION
GR096ZOtherGROUP MEDICARE PIN
CADC27012OtherLICENSE
GR096ZOtherGROUP MEDICARE PIN
GR096AMedicare PIN