Provider Demographics
NPI:1851660245
Name:ALAMEDA MARINA TREATMENT CENTER, INC
Entity Type:Organization
Organization Name:ALAMEDA MARINA TREATMENT CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:510-521-5055
Mailing Address - Street 1:1050 MARINA VILLAGE PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1099
Mailing Address - Country:US
Mailing Address - Phone:510-521-5055
Mailing Address - Fax:
Practice Address - Street 1:1050 MARINA VILLAGE PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-1099
Practice Address - Country:US
Practice Address - Phone:510-521-5055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24288111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty