Provider Demographics
NPI:1487866562
Name:EARLY CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:EARLY CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:EARLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-526-9400
Mailing Address - Street 1:3507 TULLY RD
Mailing Address - Street 2:STE. 300
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-1052
Mailing Address - Country:US
Mailing Address - Phone:209-526-9400
Mailing Address - Fax:209-526-9444
Practice Address - Street 1:3507 TULLY RD
Practice Address - Street 2:STE. 300
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-1052
Practice Address - Country:US
Practice Address - Phone:209-526-9400
Practice Address - Fax:209-526-9444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13771111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGDC000220Medicaid
CA1447628Medicare PIN