Provider Demographics
NPI:1558094961
Name:ATWAL, DALVIR S (DC)
Entity Type:Individual
Prefix:DR
First Name:DALVIR
Middle Name:S
Last Name:ATWAL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 W BEVERLY PL STE 101
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3011
Mailing Address - Country:US
Mailing Address - Phone:209-832-9221
Mailing Address - Fax:209-832-9297
Practice Address - Street 1:130 N GRANT AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-4601
Practice Address - Country:US
Practice Address - Phone:209-832-9221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-04
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36383111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty