Provider Demographics
NPI:1619443322
Name:SUSANVILLE CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:SUSANVILLE CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANVOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:530-249-3089
Mailing Address - Street 1:1723 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-4531
Mailing Address - Country:US
Mailing Address - Phone:530-257-7751
Mailing Address - Fax:530-252-4378
Practice Address - Street 1:1723 1ST ST
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-4531
Practice Address - Country:US
Practice Address - Phone:530-257-7751
Practice Address - Fax:530-252-4378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-19
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty