Provider Demographics
NPI:1902232606
Name:CASTROVILLE CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:CASTROVILLE CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:831-633-4067
Mailing Address - Street 1:11282 MERRITT ST
Mailing Address - Street 2:
Mailing Address - City:CASTROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95012-3421
Mailing Address - Country:US
Mailing Address - Phone:831-633-4067
Mailing Address - Fax:831-633-4070
Practice Address - Street 1:11282 MERRITT ST
Practice Address - Street 2:
Practice Address - City:CASTROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95012-3421
Practice Address - Country:US
Practice Address - Phone:831-633-4067
Practice Address - Fax:831-633-4070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14412261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center