Provider Demographics
NPI:1558432344
Name:LOS ALTOS MOUNTAIN VIEW CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:LOS ALTOS MOUNTAIN VIEW CHIROPRACTIC CLINIC
Other - Org Name:JAMES G PFANN DC A CHIROPRACTIC CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:PFANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:650-969-0470
Mailing Address - Street 1:1702 MIRAMONTE AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-3701
Mailing Address - Country:US
Mailing Address - Phone:650-969-0470
Mailing Address - Fax:650-969-2482
Practice Address - Street 1:1702 MIRAMONTE AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-3701
Practice Address - Country:US
Practice Address - Phone:650-969-0470
Practice Address - Fax:650-969-2482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0125040111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0125040Medicare ID - Type Unspecified
T04784Medicare UPIN