1720140106 NPI number — SAMS CHIROPRACTIC CENTER INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720140106 NPI number — SAMS CHIROPRACTIC CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAMS CHIROPRACTIC CENTER 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:
Provider Other Organization Name Type Code:
6
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:
1720140106
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5151 MURPHY CANYON RD.
Provider Second Line Business Mailing Address:
#200
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CALIFORNIA
Provider Business Mailing Address Postal Code:
92123
Provider Business Mailing Address Country Code:
UM
Provider Business Mailing Address Telephone Number:
858-569-6959
Provider Business Mailing Address Fax Number:
858-569-0240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5151 MURPHY CANYON RD
Provider Second Line Business Practice Location Address:
#200
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-4440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-569-6959
Provider Business Practice Location Address Fax Number:
858-569-0240
Provider Enumeration Date:
12/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SAMS
Authorized Official First Name:
BARON
Authorized Official Middle Name:
ASHLEY
Authorized Official Title or Position:
CHIROPRACTIC
Authorized Official Telephone Number:
858-569-0959

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  12045 , 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)





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