Provider Demographics
NPI:1821230244
Name:MCGINNIS CHIROPRACTIC PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MCGINNIS CHIROPRACTIC PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCGINNIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-253-9740
Mailing Address - Street 1:5149 MOORPARK AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-2156
Mailing Address - Country:US
Mailing Address - Phone:408-253-9740
Mailing Address - Fax:408-253-6259
Practice Address - Street 1:5149 MOORPARK AVE STE 102
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-2156
Practice Address - Country:US
Practice Address - Phone:408-253-9740
Practice Address - Fax:408-253-6259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22077111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0220770Medicare PIN