=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669531083
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOTAL FITNESS CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 39140 PASEO PADRE PKWY
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94538-1612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-791-6332
-----------------------------------------------------
Fax | 510-791-1923
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39140 PASEO PADRE PKWY
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94538-1612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-791-6332
-----------------------------------------------------
Fax | 510-791-1923
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | MRS. TINA NAFEI
-----------------------------------------------------
Credential | D.C., R.N.
-----------------------------------------------------
Telephone | 510-791-6332
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC26299
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------