Provider Demographics
NPI:1942379615
Name:CHIROPRACTIC ADVANTAGE, INC.
Entity Type:Organization
Organization Name:CHIROPRACTIC ADVANTAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR-OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:530-222-3727
Mailing Address - Street 1:1244 HARTNELL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2229
Mailing Address - Country:US
Mailing Address - Phone:530-222-3727
Mailing Address - Fax:530-222-4474
Practice Address - Street 1:1244 HARTNELL AVE STE B
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2229
Practice Address - Country:US
Practice Address - Phone:530-222-3727
Practice Address - Fax:530-222-4474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23577111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23577OtherCA LICENSE #
CA350051571OtherRR MEDICARE PIN