Provider Demographics
NPI:1518257146
Name:LI CHIROPRACTIC CENTER A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:LI CHIROPRACTIC CENTER A PROFESSIONAL CORPORATION
Other - Org Name:PROFESSIONAL CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:KIN
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:510-452-0889
Mailing Address - Street 1:388 9TH ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4287
Mailing Address - Country:US
Mailing Address - Phone:510-452-0889
Mailing Address - Fax:510-452-0912
Practice Address - Street 1:388 9TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4287
Practice Address - Country:US
Practice Address - Phone:510-452-0889
Practice Address - Fax:510-452-0912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-16
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC014126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty