Provider Demographics
NPI:1487910956
Name:PREMIER HEALTH OF PLACERVILLE INC
Entity type:Organization
Organization Name:PREMIER HEALTH OF PLACERVILLE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-622-3536
Mailing Address - Street 1:1980 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-9001
Mailing Address - Country:US
Mailing Address - Phone:530-622-3536
Mailing Address - Fax:530-622-3536
Practice Address - Street 1:1980 BROADWAY
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-9001
Practice Address - Country:US
Practice Address - Phone:530-622-3536
Practice Address - Fax:530-622-3538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15474111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1932345410OtherGROUP NPI
CABZ709AMedicare PIN
CA1932345410OtherGROUP NPI