Provider Demographics
NPI:1417211228
Name:SANTEE CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:SANTEE CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-562-8222
Mailing Address - Street 1:10763 WOODSIDE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-8106
Mailing Address - Country:US
Mailing Address - Phone:619-562-8222
Mailing Address - Fax:619-562-3106
Practice Address - Street 1:10763 WOODSIDE AVE STE A
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-8106
Practice Address - Country:US
Practice Address - Phone:619-562-8222
Practice Address - Fax:619-562-3106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC13571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1356379788OtherMICHAEL P. KELLY D.C.