1275022576 NPI number — ACC GORNEY-TUTAK CHIROPRACTIC INC

Table of content: (NPI 1275022576)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275022576 NPI number — ACC GORNEY-TUTAK CHIROPRACTIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACC GORNEY-TUTAK 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:
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:
1275022576
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1061 E MAIN ST STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRASS VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95945-5724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-615-4041
Provider Business Mailing Address Fax Number:
530-615-4043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1061 E MAIN ST STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRASS VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95945-5724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-615-4041
Provider Business Practice Location Address Fax Number:
530-615-4043
Provider Enumeration Date:
05/02/2018

Additional Information

Authorized Official

Authorized Official Last Name:
GORNEY-TUTAK
Authorized Official First Name:
VICTORIA
Authorized Official Middle Name:
MARY
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
530-615-4041

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC18807 , 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: DC18807 . This is a "LICENSED DOCTOR OF CHIROPRACTIC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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