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General NPI Number Information
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NPI Number | 1114137361
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Entity Type | Individual
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Provider Name | MATTHEW JONATHAN SANICKI D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/24/2009
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Provider Practice Location Address
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Address Line | 2751 ROOSEVELT RD BUILDING 210, SUITE 203
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City | SAN DIEGO
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State | CA
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Zip | 92106-6180
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Country | US
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Telephone | 619-795-2224
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Fax | 619-793-5517
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Provider Business Mailing Address
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Address Line | 2902 POINSETTIA DR
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City | SAN DIEGO
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State | CA
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Zip | 92106-1128
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Country | US
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Telephone | 619-501-1673
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Fax | 619-299-2212
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DC28735
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License Number State | CA
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