Provider Demographics
NPI:1407013386
Name:SHERROD CHIROPRACTIC INC
Entity type:Organization
Organization Name:SHERROD CHIROPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SHERROD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-797-3030
Mailing Address - Street 1:6530 LONETREE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5874
Mailing Address - Country:US
Mailing Address - Phone:916-797-3030
Mailing Address - Fax:916-797-0505
Practice Address - Street 1:6530 LONETREE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5874
Practice Address - Country:US
Practice Address - Phone:916-797-3030
Practice Address - Fax:916-797-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3029111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABH198Medicare PIN