Provider Demographics
NPI:1669688628
Name:VICTORIA CROOKS CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:VICTORIA CROOKS CHIROPRACTIC, INC.
Other - Org Name:VISTA VILLAGE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-630-8060
Mailing Address - Street 1:510 HACIENDA DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-6637
Mailing Address - Country:US
Mailing Address - Phone:760-630-8060
Mailing Address - Fax:760-630-7715
Practice Address - Street 1:510 HACIENDA DR
Practice Address - Street 2:SUITE 107
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6637
Practice Address - Country:US
Practice Address - Phone:760-630-8060
Practice Address - Fax:760-630-7715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACERT #COR 2472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17136Medicare ID - Type UnspecifiedMEDICARE GROUP #