Healthcare Provider Details

I. General information

NPI: 1841564218
Provider Name (Legal Business Name): MICHAEL S. CAGLE, DC A CHIROPRACTIC CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3875 TAYLOR RD SUITE 1A
LOOMIS CA
95650-9242
US

IV. Provider business mailing address

3875 TAYLOR RD SUITE 1A
LOOMIS CA
95650-9242
US

V. Phone/Fax

Practice location:
  • Phone: 916-652-0411
  • Fax: 916-652-0412
Mailing address:
  • Phone: 916-652-0411
  • Fax: 916-652-0412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number20535
License Number StateCA

VIII. Authorized Official

Name: MICHAEL S CAGLE
Title or Position: PRESIDENT
Credential:
Phone: 916-652-0411