Provider Demographics
NPI:1336391267
Name:VICTORIA CHIROPRACTIC
Entity Type:Organization
Organization Name:VICTORIA CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE/BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:FRACH
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE MANAGER
Authorized Official - Phone:408-984-2455
Mailing Address - Street 1:53 CRONIN DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-6719
Mailing Address - Country:US
Mailing Address - Phone:408-263-4599
Mailing Address - Fax:408-263-4599
Practice Address - Street 1:40 N PARK VICTORIA DR
Practice Address - Street 2:SUITE M
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-4600
Practice Address - Country:US
Practice Address - Phone:408-263-4599
Practice Address - Fax:408-263-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty