1477875854 NPI number — COMPASS CHIROPRACTIC CENTER

Table of content: (NPI 1477875854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477875854 NPI number — COMPASS CHIROPRACTIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPASS CHIROPRACTIC CENTER
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:
Provider Other Organization Name Type Code:
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:
1477875854
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7950 DUBLIN BLVD
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94568-2929
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-730-0220
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7950 DUBLIN BLVD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94568-2929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-730-0220
Provider Business Practice Location Address Fax Number:
925-463-0646
Provider Enumeration Date:
02/25/2010

Additional Information

Authorized Official

Authorized Official Last Name:
TORRES
Authorized Official First Name:
BERNARDINO
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER/CHIROPRACTOR
Authorized Official Telephone Number:
925-730-0220

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC 31191 , 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: GN088Z . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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