Provider Demographics
NPI:1518087451
Name:MCBRIDE, VICKI MARIE (DC)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:MARIE
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2646 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-5360
Mailing Address - Country:US
Mailing Address - Phone:661-723-9992
Mailing Address - Fax:661-723-9992
Practice Address - Street 1:2646 BRENTWOOD DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-5360
Practice Address - Country:US
Practice Address - Phone:661-723-9992
Practice Address - Fax:661-723-9992
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA21053OtherSTATE LICENSE
CADC21053Medicare ID - Type Unspecified