Provider Demographics
NPI:1861502205
Name:CALIFORNIA BACK SPECIALISTS MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:CALIFORNIA BACK SPECIALISTS MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHIH
Authorized Official - Last Name:CHIU
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:805-375-7900
Mailing Address - Street 1:1001 NEWBURY RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-6434
Mailing Address - Country:US
Mailing Address - Phone:805-375-7900
Mailing Address - Fax:805-375-7918
Practice Address - Street 1:1001 NEWBURY RD
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-6434
Practice Address - Country:US
Practice Address - Phone:805-375-7900
Practice Address - Fax:805-375-7918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC31784207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11081Medicare ID - Type Unspecified