Provider Demographics
NPI:1811901549
Name:DRISCOLL-NORMAN, EILEEN ANNE (DC)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:ANNE
Last Name:DRISCOLL-NORMAN
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:PO BOX 2359
Mailing Address - Street 2:
Mailing Address - City:KINGS BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:96143-2359
Mailing Address - Country:US
Mailing Address - Phone:530-546-5190
Mailing Address - Fax:530-546-5195
Practice Address - Street 1:8700 NORTH LAKE BLVD
Practice Address - Street 2:SUITE #3
Practice Address - City:KINGS BEACH
Practice Address - State:CA
Practice Address - Zip Code:96143
Practice Address - Country:US
Practice Address - Phone:530-546-5190
Practice Address - Fax:530-546-5195
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0191030Medicare UPIN