Provider Demographics
NPI:1942452941
Name:PICHA, PAUL (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:PICHA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 CITY LIMITS CIR
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1051
Mailing Address - Country:US
Mailing Address - Phone:510-735-1974
Mailing Address - Fax:
Practice Address - Street 1:1905 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2905
Practice Address - Country:US
Practice Address - Phone:510-735-1974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30876111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor