Healthcare Provider Details

I. General information

NPI: 1124572003
Provider Name (Legal Business Name): RISE BODYWORKSA BEALL CHIROPRACTIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 CENTRAL AVE
ALAMEDA CA
94501-3406
US

IV. Provider business mailing address

930 CENTRAL AVE
ALAMEDA CA
94501-3406
US

V. Phone/Fax

Practice location:
  • Phone: 408-984-2455
  • Fax: 408-984-2456
Mailing address:
  • Phone: 408-984-2455
  • Fax: 408-984-2456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC031508
License Number StateCA

VIII. Authorized Official

Name: DR. DAMON CHARLES FRACH
Title or Position: BILLING MANAGER
Credential: P.H.D.
Phone: 408-478-5092