Provider Demographics
NPI:1811260854
Name:BLUE OAK CHIROPRACTIC INCORPORATED
Entity type:Organization
Organization Name:BLUE OAK CHIROPRACTIC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:FALKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-984-6555
Mailing Address - Street 1:2260 E BIDWELL ST STE 108
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3463
Mailing Address - Country:US
Mailing Address - Phone:916-984-6555
Mailing Address - Fax:916-984-6777
Practice Address - Street 1:2260 E BIDWELL ST STE 108
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3463
Practice Address - Country:US
Practice Address - Phone:916-984-6555
Practice Address - Fax:916-984-6777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACG895AOtherMEDICARE PTAN