Healthcare Provider Details

I. General information

NPI: 1750576062
Provider Name (Legal Business Name): MONTCLAIR CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 MOUNTAIN BLVD SUITE 207
OAKLAND CA
94611-2827
US

IV. Provider business mailing address

2080 MOUNTAIN BLVD SUITE 207
OAKLAND CA
94611-2827
US

V. Phone/Fax

Practice location:
  • Phone: 510-339-9090
  • Fax:
Mailing address:
  • Phone: 510-339-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. WENDI TURNER
Title or Position: OWNER
Credential: D. C.
Phone: 510-339-9090