Provider Demographics
NPI:1952642894
Name:MAURICE K. FRETTY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:MAURICE K. FRETTY CHIROPRACTIC, INC.
Other - Org Name:OCEAN CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:K
Authorized Official - Last Name:FRETTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:415-841-0115
Mailing Address - Street 1:2549 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1613
Mailing Address - Country:US
Mailing Address - Phone:415-841-0115
Mailing Address - Fax:415-841-1710
Practice Address - Street 1:2549 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1613
Practice Address - Country:US
Practice Address - Phone:415-841-0115
Practice Address - Fax:415-841-1710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1720161276OtherINDIVIDUAL NPI NUMBER