Provider Demographics
NPI:1992878912
Name:NEWBOLD, NANCY J (DC)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:J
Last Name:NEWBOLD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:EL GRANADA
Mailing Address - State:CA
Mailing Address - Zip Code:94018-0327
Mailing Address - Country:US
Mailing Address - Phone:650-726-3300
Mailing Address - Fax:
Practice Address - Street 1:455 ALHAMBRA AVENUE
Practice Address - Street 2:
Practice Address - City:EL GRANADA
Practice Address - State:CA
Practice Address - Zip Code:94018-0327
Practice Address - Country:US
Practice Address - Phone:650-726-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0153330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT05719Medicare UPIN
CABBB32858BMedicare ID - Type Unspecified