Provider Demographics
NPI:1225254758
Name:KENDIG CHIROPRACTIC, INC
Entity type:Organization
Organization Name:KENDIG CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-296-1122
Mailing Address - Street 1:19881 HIGHWAY 88
Mailing Address - Street 2:SUITE1A
Mailing Address - City:PINE GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95665
Mailing Address - Country:US
Mailing Address - Phone:209-296-1122
Mailing Address - Fax:209-296-1142
Practice Address - Street 1:19881 HIGHWAY 8
Practice Address - Street 2:SUITE1
Practice Address - City:PINE GROVE
Practice Address - State:CA
Practice Address - Zip Code:95665
Practice Address - Country:US
Practice Address - Phone:209-296-1122
Practice Address - Fax:209-296-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13430111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty