Provider Demographics
NPI:1891860995
Name:PETERSON-BIRD CHIROPRACTIC CORP
Entity Type:Organization
Organization Name:PETERSON-BIRD CHIROPRACTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-485-1091
Mailing Address - Street 1:4616 EL CAMINO AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-6736
Mailing Address - Country:US
Mailing Address - Phone:916-485-1091
Mailing Address - Fax:916-485-7118
Practice Address - Street 1:4616 EL CAMINO AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821
Practice Address - Country:US
Practice Address - Phone:916-485-1091
Practice Address - Fax:916-485-7118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC10275111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0102750Medicare PIN