Provider Demographics
NPI:1881008514
Name:MORRO BAY CHIROPRACTIC, DR. STREET DC INC
Entity Type:Organization
Organization Name:MORRO BAY CHIROPRACTIC, DR. STREET DC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:STREET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-772-2088
Mailing Address - Street 1:580 HARBOR ST
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-1904
Mailing Address - Country:US
Mailing Address - Phone:805-772-2088
Mailing Address - Fax:
Practice Address - Street 1:580 HARBOR ST
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-1904
Practice Address - Country:US
Practice Address - Phone:805-772-2088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32966261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center