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General NPI Number Information
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NPI Number | 1851784540
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Entity Type | Organization
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Legal Business Name | VALLEY SPORT & SPINE
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 03/05/2015
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Provider Practice Location Address
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Address Line | 19151 SONOMA HWY
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City | SONOMA
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State | CA
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Zip | 95476-5449
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Country | US
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Telephone | 847-340-1715
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Fax |
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Provider Business Mailing Address
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Address Line | 19151 SONOMA HWY
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City | SONOMA
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State | CA
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Zip | 95476
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Country | US
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Telephone | 847-340-1715
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GRANT MICHAEL DOBSON
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Credential | D.C.
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Telephone | 847-340-1715
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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 | CA32312
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License Number State | CA
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