Provider Demographics
NPI:1568572956
Name:TULARE CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:TULARE CHIROPRACTIC CLINIC
Other - Org Name:TULARE ACCIDENT & INJURY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:559-685-9391
Mailing Address - Street 1:1098 E CROSS AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2925
Mailing Address - Country:US
Mailing Address - Phone:559-685-9391
Mailing Address - Fax:559-685-0545
Practice Address - Street 1:1098 E CROSS AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2925
Practice Address - Country:US
Practice Address - Phone:559-685-9391
Practice Address - Fax:559-685-0545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22412111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU49135Medicare UPIN
CADC0224120Medicare ID - Type UnspecifiedMEDICARE #