Provider Demographics
NPI:1790907483
Name:WARREN CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:WARREN CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-784-2454
Mailing Address - Street 1:1650 LEAD HILL BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3073
Mailing Address - Country:US
Mailing Address - Phone:916-784-2454
Mailing Address - Fax:916-784-0454
Practice Address - Street 1:1650 LEAD HILL BLVD STE 600
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3073
Practice Address - Country:US
Practice Address - Phone:916-784-2454
Practice Address - Fax:916-784-0454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 26593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU97991Medicare UPIN
CADC0265931Medicare ID - Type Unspecified