Provider Demographics
NPI:1588833784
Name:BAYSIDE CHIROPRACTIC, SPRAGUE & CHIU
Entity Type:Organization
Organization Name:BAYSIDE CHIROPRACTIC, SPRAGUE & CHIU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:650-591-1002
Mailing Address - Street 1:1200 BRITTAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-3931
Mailing Address - Country:US
Mailing Address - Phone:650-591-1002
Mailing Address - Fax:
Practice Address - Street 1:1200 BRITTAN AVE
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-3931
Practice Address - Country:US
Practice Address - Phone:650-591-1002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty