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General NPI Number Information
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NPI Number | 1609175447
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Entity Type | Organization
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Legal Business Name | ENSLEY CHIROPRACTIC INC.
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Dates
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Enumeration Date | 03/18/2011
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Last Update Date | 05/16/2012
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Provider Practice Location Address
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Address Line | 1313 TRAVIS BLVD SUITE B
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City | FAIRFIELD
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State | CA
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Zip | 94533-4621
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Country | US
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Telephone | 707-426-3655
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Fax |
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Provider Business Mailing Address
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Address Line | 1313 TRAVIS BLVD. SUITE B
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City | FAIRFIELD
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State | CA
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Zip | 94533
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Country | US
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Telephone | 707-426-3655
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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. ROBERT DANA ENSLEY
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Credential | DC
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Telephone | 707-426-3655
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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 | DC012399
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License Number State | CA
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