Provider Demographics
NPI:1770063117
Name:AWENDER CHIROPRACTIC INC
Entity type:Organization
Organization Name:AWENDER CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:AWENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-366-1273
Mailing Address - Street 1:2342 EL CAMINO REAL STE 100
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-2874
Mailing Address - Country:US
Mailing Address - Phone:650-366-1273
Mailing Address - Fax:650-299-8276
Practice Address - Street 1:2342 EL CAMINO REAL STE 100
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-2874
Practice Address - Country:US
Practice Address - Phone:650-366-1273
Practice Address - Fax:650-299-8276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20907111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Single Specialty