Healthcare Provider Details

I. General information

NPI: 1558867085
Provider Name (Legal Business Name): ACKERMAN CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 KENNEDY PL STE 5
DAVIS CA
95616-1272
US

IV. Provider business mailing address

949 PONDEROSA PL
DAVIS CA
95616-2140
US

V. Phone/Fax

Practice location:
  • Phone: 530-650-5265
  • Fax:
Mailing address:
  • Phone: 707-832-9623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number34069
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL DAVID ACKERMAN
Title or Position: OWNER
Credential: DC
Phone: 707-832-9623