Provider Demographics
NPI:1770924326
Name:BARTLETT CHIROPRACTIC, INC
Entity type:Organization
Organization Name:BARTLETT CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARTLETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:707-579-8150
Mailing Address - Street 1:2718 TACHEVAH DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-8420
Mailing Address - Country:US
Mailing Address - Phone:707-579-8150
Mailing Address - Fax:707-579-8161
Practice Address - Street 1:2718 TACHEVAH DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-8420
Practice Address - Country:US
Practice Address - Phone:707-579-8150
Practice Address - Fax:707-579-8161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23426261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0234260Medicare PIN
CAU51608Medicare UPIN