1316008634 NPI number — FALKENROTH CHIROPRACTIC INC

Table of content: (NPI 1316008634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316008634 NPI number — FALKENROTH CHIROPRACTIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FALKENROTH CHIROPRACTIC INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FIVE STAR CHIROPRACTIC CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316008634
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11022 WINNERS CIR
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
LOS ALAMITOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90720-2883
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-430-9479
Provider Business Mailing Address Fax Number:
562-430-9473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2959 PARK AVE STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOQUEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95073-2863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-475-8600
Provider Business Practice Location Address Fax Number:
831-475-8601
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FALKENROTH
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
831-475-8600

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC25861 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1992800833 . This is a "INDIVIDUAL NPI NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DC25861 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ64963Z . This is a "BLUE SHIELD ID#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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