Provider Demographics
NPI:1770582512
Name:GARCIA, ELIZABETH (DC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W BATTLES RD STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7114
Mailing Address - Country:US
Mailing Address - Phone:805-925-1470
Mailing Address - Fax:805-314-2904
Practice Address - Street 1:121 W BATTLES RD STE A
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-7114
Practice Address - Country:US
Practice Address - Phone:805-925-1470
Practice Address - Fax:805-314-2904
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3454111N00000X
TX5551111N00000X
NM1244111N00000X
CA24132111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0241320OtherBLUE SHIELD
U05754Medicare UPIN