Provider Demographics
NPI:1811124324
Name:CALIFORNIA CHIROPRACTIC CLINIC INC.
Entity type:Organization
Organization Name:CALIFORNIA CHIROPRACTIC CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHNAZ
Authorized Official - Middle Name:M
Authorized Official - Last Name:OGABIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-288-8999
Mailing Address - Street 1:259 MERIDIAN AVE
Mailing Address - Street 2:STE 6
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2905
Mailing Address - Country:US
Mailing Address - Phone:408-288-8999
Mailing Address - Fax:408-288-8922
Practice Address - Street 1:259 MERIDIAN AVE
Practice Address - Street 2:STE 6
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2905
Practice Address - Country:US
Practice Address - Phone:408-288-8999
Practice Address - Fax:408-288-8922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23455111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty