Provider Demographics
NPI: | 1265657829 |
---|---|
Name: | CHIROPRACTIC CARE |
Entity type: | Organization |
Organization Name: | CHIROPRACTIC CARE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIROPRACTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JAMIE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CHANG |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 408-937-8988 |
Mailing Address - Street 1: | 244 N JACKSON AVE |
Mailing Address - Street 2: | SUITE 205 |
Mailing Address - City: | SAN JOSE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 95116-1604 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 408-937-8988 |
Mailing Address - Fax: | 408-937-8222 |
Practice Address - Street 1: | 244 N JACKSON AVE |
Practice Address - Street 2: | SUITE 205 |
Practice Address - City: | SAN JOSE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95116-1604 |
Practice Address - Country: | US |
Practice Address - Phone: | 408-937-8988 |
Practice Address - Fax: | 408-937-8222 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-04-17 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | DC25202 | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |