Provider Demographics
NPI:1811154966
Name:DOWELL HOOGENDOORN CHIROPRACTIC INC
Entity type:Organization
Organization Name:DOWELL HOOGENDOORN CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:HOOGENDOORN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-239-1355
Mailing Address - Street 1:440 EAST CENTER STREET
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336
Mailing Address - Country:US
Mailing Address - Phone:209-239-1355
Mailing Address - Fax:209-239-7091
Practice Address - Street 1:440 EAST CENTER STREET
Practice Address - Street 2:
Practice Address - City:MENTECA
Practice Address - State:CA
Practice Address - Zip Code:95336
Practice Address - Country:US
Practice Address - Phone:209-239-1355
Practice Address - Fax:209-239-7091
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOWELL HOOGENDOORN CHIROPRACTIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0097220111N00000X
CADC017940111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty