Provider Demographics
NPI:1497138424
Name:STARK FAMILY CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:STARK FAMILY CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/ CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYSA
Authorized Official - Middle Name:NEMIROFF
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-887-7009
Mailing Address - Street 1:17922 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5039
Mailing Address - Country:US
Mailing Address - Phone:714-887-7009
Mailing Address - Fax:714-968-4384
Practice Address - Street 1:17922 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5039
Practice Address - Country:US
Practice Address - Phone:714-887-7009
Practice Address - Fax:714-968-4384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty