Provider Demographics
NPI:1386497998
Name:BAYACAL, ARCHIE (DC)
Entity type:Individual
Prefix:
First Name:ARCHIE
Middle Name:
Last Name:BAYACAL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12752 VALLEY VIEW ST STE D
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-2500
Mailing Address - Country:US
Mailing Address - Phone:714-622-5459
Mailing Address - Fax:
Practice Address - Street 1:12752 VALLEY VIEW ST STE D
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-2500
Practice Address - Country:US
Practice Address - Phone:714-622-5459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36853111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor