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General NPI Number Information
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NPI Number | 1063644060
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Entity Type | Organization
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Legal Business Name | GONSTEAD FAMILY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 08/10/2009
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 10988 COMBIE RD STE 100
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City | AUBURN
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State | CA
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Zip | 95602-8987
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Country | US
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Telephone | 530-268-1386
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Fax |
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Provider Business Mailing Address
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Address Line | 10988 COMBIE RD STE 100
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City | AUBURN
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State | CA
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Zip | 95602-8987
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Country | US
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Telephone | 530-268-1386
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. DALLAN RAYMOND PACKARD
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Credential | D.C.
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Telephone | 808-492-7986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 33888
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License Number State | CA
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