Provider Demographics
NPI:1609050962
Name:KIRK CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:KIRK CHIROPRACTIC, INC.
Other - Org Name:AMADOR VALLEY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:O
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:IV
Authorized Official - Credentials:DC QME
Authorized Official - Phone:925-484-0191
Mailing Address - Street 1:148 RAY ST STE A
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6649
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:925-484-0194
Practice Address - Street 1:148 RAY ST STE A
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6649
Practice Address - Country:US
Practice Address - Phone:925-484-0191
Practice Address - Fax:925-484-0194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25729111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0257290Medicare UPIN
CADC0257080Medicare UPIN