=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033429022
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCBRIDE CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2010
-----------------------------------------------------
Last Update Date | 10/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 FRUITVALE AVE 2ND FLOOR
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94601-2956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-533-5353
-----------------------------------------------------
Fax | 510-533-5552
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 FRUITVALE AVE 2ND FLOOR
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94601-2956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-533-5353
-----------------------------------------------------
Fax | 510-533-5552
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. PAUL MCBRIDE
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 510-533-5353
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC26297
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------