Basic Information
| Provider Information | |||||||||
| NPI: | 1255487757 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BISSELL CHIROPRACTIC CLINIC INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1470 EAST VALLEY ROAD | ||||||||
| Address2: | SUITE M | ||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055655252 | ||||||||
| FaxNumber: | 8055655250 | ||||||||
| Practice Location | |||||||||
| Address1: | 1470 EAST VALLEY ROAD | ||||||||
| Address2: | SUITE M | ||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055655252 | ||||||||
| FaxNumber: | 8055655250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BISSELL | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8055655252 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | SR. | ||||||||
| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111NS0005X | CA | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor | Sports Physician | 225100000X | CA | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.