Provider Demographics
NPI:1790854198
Name:PACKARD, DAVID A (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:PACKARD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 S HARBOR BLVD
Mailing Address - Street 2:SUITE 129, PMB536
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-4136
Mailing Address - Country:US
Mailing Address - Phone:805-201-0500
Mailing Address - Fax:
Practice Address - Street 1:3600 S HARBOR BLVD
Practice Address - Street 2:STE 129, PMB 536
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93035
Practice Address - Country:US
Practice Address - Phone:805-201-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27631111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor