Healthcare Provider Details

I. General information

NPI: 1669502027
Provider Name (Legal Business Name): ATWATER CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 FIRST STREET
ATWATER CA
95301
US

IV. Provider business mailing address

2601 FIRST STREET
ATWATER CA
95301
US

V. Phone/Fax

Practice location:
  • Phone: 209-358-6464
  • Fax: 209-358-6534
Mailing address:
  • Phone: 209-358-6464
  • Fax: 209-358-6534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number14111
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number28612
License Number StateCA

VIII. Authorized Official

Name: MRS. LORENA ORNELAS
Title or Position: BILLING ADMIN
Credential:
Phone: 209-358-6464