Healthcare Provider Details

I. General information

NPI: 1013357821
Provider Name (Legal Business Name): AMBROSE CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

350 GREEN VALLEY RD
EL DORADO HILLS CA
95762-3927
US

IV. Provider business mailing address

350 GREEN VALLEY RD
EL DORADO HILLS CA
95762-3927
US

V. Phone/Fax

Practice location:
  • Phone: 916-933-6700
  • Fax:
Mailing address:
  • Phone: 916-933-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberDC18301
License Number StateCA

VIII. Authorized Official

Name: DR. JOSEPH R AMBROSE
Title or Position: PRESIDENT
Credential: DC
Phone: 916-933-6700