Provider Demographics
NPI:1184271843
Name:PASSPORT TO HEALTH A GASTON CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:PASSPORT TO HEALTH A GASTON CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEVON
Authorized Official - Middle Name:
Authorized Official - Last Name:GASTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-984-4128
Mailing Address - Street 1:1741 CREEKSIDE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3457
Mailing Address - Country:US
Mailing Address - Phone:916-984-4128
Mailing Address - Fax:916-790-8504
Practice Address - Street 1:1741 CREEKSIDE DR STE 100
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3457
Practice Address - Country:US
Practice Address - Phone:916-984-4128
Practice Address - Fax:916-790-8504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty