Provider Demographics
NPI:1689119745
Name:MACCHESNEY CHIROPRACTIC
Entity Type:Organization
Organization Name:MACCHESNEY CHIROPRACTIC
Other - Org Name:SAN LEANDRO CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:MACCHESNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:510-346-0700
Mailing Address - Street 1:144 JOAQUIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4708
Mailing Address - Country:US
Mailing Address - Phone:510-346-0700
Mailing Address - Fax:510-357-2133
Practice Address - Street 1:144 JOAQUIN AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4708
Practice Address - Country:US
Practice Address - Phone:510-346-0700
Practice Address - Fax:510-357-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24683111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0246830Medicare PIN