Healthcare Provider Details

I. General information

NPI: 1609175447
Provider Name (Legal Business Name): ENSLEY CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 TRAVIS BLVD SUITE B
FAIRFIELD CA
94533-4621
US

IV. Provider business mailing address

1313 TRAVIS BLVD. SUITE B
FAIRFIELD CA
94533
US

V. Phone/Fax

Practice location:
  • Phone: 707-426-3655
  • Fax:
Mailing address:
  • Phone: 707-426-3655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC012399
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT DANA ENSLEY
Title or Position: PRESIDENT
Credential: DC
Phone: 707-426-3655