Provider Demographics
NPI:1548244957
Name:CHEELEY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:CHEELEY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EVERETT
Authorized Official - Last Name:CHEELEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:909-533-4591
Mailing Address - Street 1:900 E WASHINGTON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-8182
Mailing Address - Country:US
Mailing Address - Phone:909-533-4591
Mailing Address - Fax:909-533-4597
Practice Address - Street 1:900 E WASHINGTON ST STE 300
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-8182
Practice Address - Country:US
Practice Address - Phone:909-533-4591
Practice Address - Fax:909-533-4597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2019-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13290111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T04957Medicare UPIN
ZZZ28803ZMedicare ID - Type Unspecified