Provider Demographics
NPI:1720051238
Name:PUBLICO CHIROPRACTIC INC
Entity Type:Organization
Organization Name:PUBLICO CHIROPRACTIC INC
Other - Org Name:BEACH CITIES CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MASTERS-PUBLICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-434-1756
Mailing Address - Street 1:2958 MADISON ST.
Mailing Address - Street 2:SUITE #101
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008
Mailing Address - Country:US
Mailing Address - Phone:760-434-1756
Mailing Address - Fax:760-434-2482
Practice Address - Street 1:2958 MADISON ST.
Practice Address - Street 2:SUITE #101
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008
Practice Address - Country:US
Practice Address - Phone:760-434-1756
Practice Address - Fax:760-434-2482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30631111N00000X
CADC17868111N00000X
CADC29643111N00000X
CA13855111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT05151Medicare UPIN
CAW18736Medicare ID - Type Unspecified