Provider Demographics
NPI:1861502700
Name:CRAVIOTTO CHIROPRACTIC CORP.
Entity Type:Organization
Organization Name:CRAVIOTTO CHIROPRACTIC CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY OF THE CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:CRAVIOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-688-5545
Mailing Address - Street 1:PO BOX 883
Mailing Address - Street 2:
Mailing Address - City:LOS OLIVOS
Mailing Address - State:CA
Mailing Address - Zip Code:93441-0883
Mailing Address - Country:US
Mailing Address - Phone:805-688-5545
Mailing Address - Fax:805-688-5676
Practice Address - Street 1:2922 DE LA VINA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3372
Practice Address - Country:US
Practice Address - Phone:805-563-0007
Practice Address - Fax:805-682-7075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14695Medicare ID - Type Unspecified