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General NPI Number Information
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NPI Number | 1205146040
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Entity Type | Organization
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Legal Business Name | ROCKLIN FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 10/14/2010
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Last Update Date | 10/14/2010
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Provider Practice Location Address
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Address Line | 4441 GRANITE DR SUITE 102
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City | ROCKLIN
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State | CA
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Zip | 95677-2283
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Country | US
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Telephone | 916-625-0208
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Fax | 916-625-0209
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Provider Business Mailing Address
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Address Line | 4441 GRANITE DR SUITE 102
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City | ROCKLIN
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State | CA
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Zip | 95677-2283
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Country | US
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Telephone | 916-625-0208
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Fax | 916-625-0209
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. ERIC WAGNON
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Credential | D.C.
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Telephone | 916-625-0208
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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 | 30897
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License Number State | CA
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