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General NPI Number Information
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NPI Number | 1245661115
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Entity Type | Organization
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Legal Business Name | IN MOTION SPORTS AND FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 12/03/2013
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Last Update Date | 12/03/2013
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Provider Practice Location Address
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Address Line | 2165 4TH ST STE A
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City | LIVERMORE
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State | CA
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Zip | 94550-4568
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Country | US
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Telephone | 925-292-5850
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Fax |
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Provider Business Mailing Address
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Address Line | 2165 4TH ST STE A
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City | LIVERMORE
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State | CA
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Zip | 94550-4568
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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 | CHIROPRACTOR
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Name | MANUEL ERNESTO VALLE
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Credential |
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Telephone | 925-292-5850
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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 | DC30801
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License Number State | CA
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