Provider Demographics
NPI:1659729051
Name:GARRIDO, RUSSELL & COYKENDALL CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:GARRIDO, RUSSELL & COYKENDALL CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:COYKENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-612-5884
Mailing Address - Street 1:438 W BEVERLY PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3011
Mailing Address - Country:US
Mailing Address - Phone:209-832-9221
Mailing Address - Fax:209-832-9297
Practice Address - Street 1:130 N GRANT AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-4601
Practice Address - Country:US
Practice Address - Phone:209-825-5610
Practice Address - Fax:209-825-4028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30707111N00000X
CADC30800111N00000X
CADC26617111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty