Provider Demographics
NPI:1013110915
Name:SAN RAMON CHIROPRACTIC OFFICE
Entity type:Organization
Organization Name:SAN RAMON CHIROPRACTIC OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEEDEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:VALDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-828-0616
Mailing Address - Street 1:9260 ALCOSTA BLVD
Mailing Address - Street 2:B-12
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4134
Mailing Address - Country:US
Mailing Address - Phone:925-828-0616
Mailing Address - Fax:925-828-2412
Practice Address - Street 1:9260 ALCOSTA BLVD
Practice Address - Street 2:B-12
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4134
Practice Address - Country:US
Practice Address - Phone:925-828-0616
Practice Address - Fax:925-828-2412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05 05615111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0127470Medicare ID - Type UnspecifiedDR. LEONARD
CAT04882Medicare UPIN
CADC0116250Medicare ID - Type UnspecifiedDR. MIKLEBOST
CAT04423Medicare UPIN