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General NPI Number Information
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NPI Number | 1255865085
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Entity Type | Organization
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Legal Business Name | EGAN FAMILY CHIROPRACTIC INC.
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Dates
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Enumeration Date | 04/19/2017
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Last Update Date | 04/19/2017
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Provider Practice Location Address
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Address Line | 45 MITCHELL BLVD STE 9
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City | SAN RAFAEL
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State | CA
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Zip | 94903-2011
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Country | US
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Telephone | 415-785-7131
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Fax |
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Provider Business Mailing Address
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Address Line | 45 MITCHELL BLVD STE 9
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City | SAN RAFAEL
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State | CA
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Zip | 94903-2011
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Country | US
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Telephone | 415-785-7131
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW NICHOALS EGAN
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Credential | D.C.
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Telephone | 415-785-7131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 31550
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License Number State | CA
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