Provider Demographics
NPI:1396029435
Name:SPURLOCK CHIROPRACTIC SPINAL DECOMPRESSION CLINIC, INC
Entity Type:Organization
Organization Name:SPURLOCK CHIROPRACTIC SPINAL DECOMPRESSION CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MADISON
Authorized Official - Last Name:SPURLOCK
Authorized Official - Suffix:IV
Authorized Official - Credentials:DC
Authorized Official - Phone:707-223-1682
Mailing Address - Street 1:1318 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3916
Mailing Address - Country:US
Mailing Address - Phone:805-540-2010
Mailing Address - Fax:
Practice Address - Street 1:1318 GARDEN ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3916
Practice Address - Country:US
Practice Address - Phone:805-540-2010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA28858261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center