Provider Demographics
NPI:1821292194
Name:WIRICK CHIROPRACTIC CARE
Entity Type:Organization
Organization Name:WIRICK CHIROPRACTIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:WIRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:707-935-4330
Mailing Address - Street 1:813 W NAPA ST
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6414
Mailing Address - Country:US
Mailing Address - Phone:707-935-4330
Mailing Address - Fax:707-935-4333
Practice Address - Street 1:813 W NAPA ST
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6414
Practice Address - Country:US
Practice Address - Phone:707-935-4330
Practice Address - Fax:707-935-4333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19651111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC029128Medicare ID - Type Unspecified
CADC0196510Medicare ID - Type Unspecified