Provider Demographics
NPI:1972826881
Name:SPINAL HEALTH CHIROPRACTIC
Entity Type:Organization
Organization Name:SPINAL HEALTH CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:650-756-9003
Mailing Address - Street 1:2340 SANTA RITA RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-4151
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2340 SANTA RITA RD
Practice Address - Street 2:SUITE #3
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4151
Practice Address - Country:US
Practice Address - Phone:650-756-9003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28615111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0286150OtherMEDICARE PTAN