Healthcare Provider Details

I. General information

NPI: 1881738623
Provider Name (Legal Business Name): NIHAD CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1052 RIVARA RD
STOCKTON CA
95207-1824
US

IV. Provider business mailing address

PO BOX 692077
STOCKTON CA
95269-2077
US

V. Phone/Fax

Practice location:
  • Phone: 209-956-5699
  • Fax: 209-956-5558
Mailing address:
  • Phone: 209-956-5699
  • Fax: 209-956-5558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC19233
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC19233
License Number StateCA

VIII. Authorized Official

Name: DR. OTHMAN NIHAD
Title or Position: CEO
Credential: D.C.,M.P.T.
Phone: 209-956-5699