Provider Demographics
NPI:1992028021
Name:DESMARAIS CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:DESMARAIS CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:ROLAND
Authorized Official - Last Name:DESMARAIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:650-588-9962
Mailing Address - Street 1:1405 HUNTINGTON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5965
Mailing Address - Country:US
Mailing Address - Phone:650-588-9962
Mailing Address - Fax:650-588-9964
Practice Address - Street 1:1405 HUNTINGTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5965
Practice Address - Country:US
Practice Address - Phone:650-588-9962
Practice Address - Fax:650-588-9964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20163111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty