Basic Information
| Provider Information | |||||||||
| NPI: | 1174297188 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CALZARETTA SPORTS CHIROPRACTIC INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1848 | ||||||||
| Address2: | |||||||||
| City: | NOVATO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949481848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154952225 | ||||||||
| FaxNumber: | 4154952228 | ||||||||
| Practice Location | |||||||||
| Address1: | THREE EMBARCADERO CENTER, LL5 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154952225 | ||||||||
| FaxNumber: | 4154952228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2021 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| AuthorizedOfficialLastName: | QUINN | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER OF ADMIN OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 4154952225 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.