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General NPI Number Information
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NPI Number | 1194079194
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Entity Type | Organization
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Legal Business Name | CALIFORNIA CHIROPRACTIC WELLNESS CORPORATION
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Dates
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Enumeration Date | 10/30/2012
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Last Update Date | 10/30/2012
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Provider Practice Location Address
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Address Line | 6839 FIVE STAR BLVD SUITE F
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City | ROCKLIN
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State | CA
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Zip | 95677
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Country | US
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Telephone | 408-960-4236
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Fax |
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Provider Business Mailing Address
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Address Line | 6839 FIVE STAR BLVD SUITE F
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City | ROCKLIN
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State | CA
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Zip | 95677
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Country | US
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Telephone | 408-960-4236
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. TIMOTHY ALAN SMITH
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Credential | D.C.
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Telephone | 408-960-4236
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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 | DC-31678
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License Number State | CA
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