Provider Demographics
NPI:1669502027
Name:ATWATER CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:ATWATER CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORNELAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-358-6464
Mailing Address - Street 1:2601 FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301
Mailing Address - Country:US
Mailing Address - Phone:209-358-6464
Mailing Address - Fax:209-358-6534
Practice Address - Street 1:2601 FIRST STREET
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301
Practice Address - Country:US
Practice Address - Phone:209-358-6464
Practice Address - Fax:209-358-6534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14111111N00000X
CA28612111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0141110Medicare ID - Type Unspecified
CADC0286120Medicare ID - Type Unspecified