Healthcare Provider Details

I. General information

NPI: 1386905990
Provider Name (Legal Business Name): EADE CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 LINCOLN AVE STE 225
NAPA CA
94558-3664
US

IV. Provider business mailing address

575 LINCOLN AVE STE 225
NAPA CA
94558-3664
US

V. Phone/Fax

Practice location:
  • Phone: 707-255-6888
  • Fax: 707-255-1827
Mailing address:
  • Phone: 707-255-6888
  • Fax: 707-255-1827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberDC 25857
License Number StateCA

VIII. Authorized Official

Name: TAMI LYNN EADE
Title or Position: VICE PRESIDENT
Credential: DC
Phone: 707-255-6888