Provider Demographics
NPI:1417126293
Name:BARATTA CHIROPRACTIC INC
Entity Type:Organization
Organization Name:BARATTA CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARATTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-979-0716
Mailing Address - Street 1:15550 ROCKFIELD BLVD
Mailing Address - Street 2:B220
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2720
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:6728 FAIR OAKS BLVD
Practice Address - Street 2:300
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-3827
Practice Address - Country:US
Practice Address - Phone:916-979-0716
Practice Address - Fax:916-979-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24081111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0240810OtherBLUE SHIELD
CADC24081OtherCHIROPRACTIC LICENSE
CAZZZ07746ZOtherGROUP PTAN
CA1730209586OtherINDIVIDUAL NPI
CADC0240811OtherINDIVIDUAL PTAN