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General NPI Number Information
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NPI Number | 1609107770
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Entity Type | Organization
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Legal Business Name | DOBLE CHIROPRACTIC CORP
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Dates
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Enumeration Date | 01/28/2010
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Last Update Date | 01/28/2010
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Provider Practice Location Address
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Address Line | 130 S MAIN ST STE 203
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City | SEBASTOPOL
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State | CA
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Zip | 95472-4241
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Country | US
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Telephone | 707-823-9355
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Fax |
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Provider Business Mailing Address
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Address Line | 130 S MAIN ST STE 203
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City | SEBASTOPOL
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State | CA
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Zip | 95472-4241
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Country | US
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Telephone | 707-823-9355
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD W. DOBLE JR.
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Credential | DC
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Telephone | 707-823-9355
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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 | DC22993
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License Number State | CA
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