Provider Demographics
NPI:1528105780
Name:CALIFORNIA CHIROPRACTIC
Entity type:Organization
Organization Name:CALIFORNIA CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BOSHEARS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:909-790-5005
Mailing Address - Street 1:35191 YUCAIPA BLVD
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-4338
Mailing Address - Country:US
Mailing Address - Phone:909-790-5005
Mailing Address - Fax:909-790-5009
Practice Address - Street 1:35191 YUCAIPA BLVD
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-4338
Practice Address - Country:US
Practice Address - Phone:909-790-5005
Practice Address - Fax:909-790-5009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC270160111N00000X
CADC268440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0268440Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION
CADC0270160Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION