Provider Demographics
NPI:1649343708
Name:BIVOLCIC ROE CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:BIVOLCIC ROE CHIROPRACTIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DELENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BIVOLCIC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:510-450-1144
Mailing Address - Street 1:6333 TELEGRAPH AVE
Mailing Address - Street 2:SUITE #203
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1359
Mailing Address - Country:US
Mailing Address - Phone:510-450-1144
Mailing Address - Fax:510-450-1147
Practice Address - Street 1:6333 TELEGRAPH AVE
Practice Address - Street 2:SUITE #203
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1359
Practice Address - Country:US
Practice Address - Phone:510-450-1144
Practice Address - Fax:510-450-1147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2012-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID
CA=========OtherTAX ID