Provider Demographics
NPI:1629219126
Name:CASTO CHIROPRACTIC INC
Entity Type:Organization
Organization Name:CASTO CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:530-543-1201
Mailing Address - Street 1:15520 ROCKFIELD BLVD STE A200
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-6705
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:1156 EMERALD BAY RD
Practice Address - Street 2:BLDG. C
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-6157
Practice Address - Country:US
Practice Address - Phone:530-543-1201
Practice Address - Fax:530-543-1322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28482111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC28482OtherCHIROPRACTIC LICENSE
CAZZZ53912YOtherBLUE SHIELD
CADA009ZOtherINDIVIDUAL PTAN
CA1427145911OtherINDIVIDUAL NPI
CA1427145911OtherINDIVIDUAL NPI