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General NPI Number Information
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NPI Number | 1437262276
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Entity Type | Organization
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Legal Business Name | CANYON LAKES CHIROPRACTIC GROUP
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 08/05/2008
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Provider Practice Location Address
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Address Line | 500 BOLLINGER CANYON WAY STE 15A
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City | SAN RAMON
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State | CA
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Zip | 94582-5252
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Country | US
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Telephone | 925-735-8508
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Fax | 925-735-2374
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Provider Business Mailing Address
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Address Line | 500 BOLLINGER CANYON WAY STE 15A
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City | SAN RAMON
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State | CA
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Zip | 94582-5252
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Country | US
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Telephone | 925-735-8508
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Fax | 925-735-2374
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Authorized Official
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Title or Position | OWNER
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Name | AUDRA SAUL
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Credential | D.C.
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Telephone | 925-735-8508
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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-23525
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License Number State | CA
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