Healthcare Provider Details

I. General information

NPI: 1528331394
Provider Name (Legal Business Name): OAKLEY CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3478 MAIN ST
OAKLEY CA
94561-3137
US

IV. Provider business mailing address

PO BOX 8
OAKLEY CA
94561-0008
US

V. Phone/Fax

Practice location:
  • Phone: 925-625-1881
  • Fax: 925-625-4769
Mailing address:
  • Phone: 925-625-1881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHAEL J PAINTER
Title or Position: CHIROPRACTOR/PRESIDENT
Credential: D.C.
Phone: 925-625-1881