Provider Demographics
NPI:1821175449
Name:VICTORIA REYZELMAN
Entity Type:Organization
Organization Name:VICTORIA REYZELMAN
Other - Org Name:CONSCIOUS CHIROPRACTIC & ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:KANZAWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-677-9900
Mailing Address - Street 1:220 MONTGOMERY ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-3402
Mailing Address - Country:US
Mailing Address - Phone:415-677-9900
Mailing Address - Fax:415-358-5803
Practice Address - Street 1:220 MONTGOMERY ST
Practice Address - Street 2:SUITE 305
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-3402
Practice Address - Country:US
Practice Address - Phone:415-677-9900
Practice Address - Fax:415-358-5803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU98236Medicare UPIN
CADC28017Medicare ID - Type UnspecifiedMEDICARE