Provider Demographics
NPI:1427107069
Name:TAATJES CHIROPRACTIC INC.
Entity type:Organization
Organization Name:TAATJES CHIROPRACTIC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAATJES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:707-763-8910
Mailing Address - Street 1:937 LAKEVILLE ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3329
Mailing Address - Country:US
Mailing Address - Phone:707-763-8910
Mailing Address - Fax:707-763-7348
Practice Address - Street 1:937 LAKEVILLE ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3329
Practice Address - Country:US
Practice Address - Phone:707-763-8910
Practice Address - Fax:707-763-7348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19627111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABX273AOtherMEDICARE PTAN
CADC0196270Medicare ID - Type Unspecified
CABX273AOtherMEDICARE PTAN