Provider Demographics
NPI:1760685911
Name:FULANOVICH AND SEID CHIROPRACTIC
Entity Type:Organization
Organization Name:FULANOVICH AND SEID CHIROPRACTIC
Other - Org Name:PALO ALTO CHIROPRACTIC OFFICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:SEID
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:650-328-2100
Mailing Address - Street 1:1691 EL CAMINO REAL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1009
Mailing Address - Country:US
Mailing Address - Phone:650-328-2100
Mailing Address - Fax:650-328-2104
Practice Address - Street 1:1691 EL CAMINO REAL
Practice Address - Street 2:SUITE 100
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306
Practice Address - Country:US
Practice Address - Phone:650-328-2100
Practice Address - Fax:650-328-2104
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FULANOVICH AND SEID CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-06
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0115810Medicare ID - Type Unspecified
CAT04407Medicare UPIN