Provider Demographics
NPI:1487851176
Name:LAVIN CHIROPRACTIC
Entity Type:Organization
Organization Name:LAVIN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:S
Authorized Official - Last Name:LAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:510-727-0660
Mailing Address - Street 1:20995 REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5919
Mailing Address - Country:US
Mailing Address - Phone:510-727-0660
Mailing Address - Fax:510-727-1880
Practice Address - Street 1:20995 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5919
Practice Address - Country:US
Practice Address - Phone:510-727-0660
Practice Address - Fax:510-727-1880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19889111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0198890Medicare ID - Type Unspecified