Provider Demographics
NPI:1619208311
Name:ACKER CHIROPRACTIC INC
Entity Type:Organization
Organization Name:ACKER CHIROPRACTIC INC
Other - Org Name:ACKER CHIROPRACTIC & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ACKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-770-9133
Mailing Address - Street 1:33669 DATE PALM DR
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-4730
Mailing Address - Country:US
Mailing Address - Phone:760-770-9133
Mailing Address - Fax:760-770-7383
Practice Address - Street 1:33669 DATE PALM DR
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-4730
Practice Address - Country:US
Practice Address - Phone:760-770-9133
Practice Address - Fax:760-770-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-26174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty