Provider Demographics
NPI:1437686235
Name:GAVIN CARR CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:GAVIN CARR CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:CARR
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:650-326-7000
Mailing Address - Street 1:489 MIDDLEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-1347
Mailing Address - Country:US
Mailing Address - Phone:650-326-7000
Mailing Address - Fax:650-326-7002
Practice Address - Street 1:489 MIDDLEFIELD RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1347
Practice Address - Country:US
Practice Address - Phone:650-326-7000
Practice Address - Fax:650-326-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19946111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty