Provider Demographics
NPI:1710209317
Name:GREGORY A CELAYA CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:GREGORY A CELAYA CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:A
Authorized Official - Last Name:CELAYA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-371-6144
Mailing Address - Street 1:1325 E THOUSAND OAKS BLVD
Mailing Address - Street 2:#104
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-2822
Mailing Address - Country:US
Mailing Address - Phone:805-371-6144
Mailing Address - Fax:
Practice Address - Street 1:1325 E THOUSAND OAKS BLVD
Practice Address - Street 2:#104
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-2822
Practice Address - Country:US
Practice Address - Phone:805-371-6144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17612111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT18578Medicare UPIN