Healthcare Provider Details

I. General information

NPI: 1053513267
Provider Name (Legal Business Name): IONE FAMILY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 CLAY STREET
IONE CA
95640
US

IV. Provider business mailing address

PO BOX 17
IONE CA
95640
US

V. Phone/Fax

Practice location:
  • Phone: 209-274-2000
  • Fax: 209-274-9490
Mailing address:
  • Phone: 209-274-2000
  • Fax: 209-274-9490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number16602
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number20577
License Number StateCA

VIII. Authorized Official

Name: DR. CHARLES EDGAR DUNBAR
Title or Position: CHIROPRACTIC OWNER
Credential: DC
Phone: 209-274-2000