Provider Demographics
NPI:1154423986
Name:INTEGRITY CHIROPRACTIC A JEFF LISTIAK PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:INTEGRITY CHIROPRACTIC A JEFF LISTIAK PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:LISTIAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-230-2939
Mailing Address - Street 1:171 SAXONY RD STE 113
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-6776
Mailing Address - Country:US
Mailing Address - Phone:760-230-2939
Mailing Address - Fax:
Practice Address - Street 1:171 SAXONY RD STE 113
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-6776
Practice Address - Country:US
Practice Address - Phone:760-230-2939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACOR 2748111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty