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General NPI Number Information
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NPI Number | 1114363413
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Entity Type | Organization
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Legal Business Name | EVOKE SPINAL CARE
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Dates
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Enumeration Date | 05/14/2013
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Last Update Date | 05/14/2013
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Provider Practice Location Address
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Address Line | 391 TAYLOR BLVD STE 130
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City | PLEASANT HILL
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State | CA
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Zip | 94523-2257
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Country | US
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Telephone | 925-523-1022
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Fax |
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Provider Business Mailing Address
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Address Line | 391 TAYLOR BLVD STE 130
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City | PLEASANT HILL
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State | CA
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Zip | 94523-2257
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. FREDRICK J DIETZEN
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Credential | DC
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Telephone | 925-523-1022
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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 | 32227
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License Number State | CA
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