Provider Demographics
NPI:1972759488
Name:WESTSIDE CHIROPRACTIC
Entity type:Organization
Organization Name:WESTSIDE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUDOVICO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:650-349-2222
Mailing Address - Street 1:190 W 25TH AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-2272
Mailing Address - Country:US
Mailing Address - Phone:650-349-2222
Mailing Address - Fax:650-341-3415
Practice Address - Street 1:190 W 25TH AVE STE 4
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-2272
Practice Address - Country:US
Practice Address - Phone:650-349-2222
Practice Address - Fax:650-341-3415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25468111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty