Provider Demographics
NPI:1609301423
Name:VON STADE CHIROPRACTIC INC
Entity Type:Organization
Organization Name:VON STADE CHIROPRACTIC INC
Other - Org Name:GOLDEN GATE CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:VON STADE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:415-563-4424
Mailing Address - Street 1:2920 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-4006
Mailing Address - Country:US
Mailing Address - Phone:415-563-4424
Mailing Address - Fax:
Practice Address - Street 1:2920 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4006
Practice Address - Country:US
Practice Address - Phone:415-563-4424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-30
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty