Basic Information
Provider Information | |||||||||
NPI: | 1821630765 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SISKIYOU CHIROPRACTIC & MASSAGE | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1744 E MCANDREWS RD STE D | ||||||||
Address2: |   | ||||||||
City: | MEDFORD | ||||||||
State: | OR | ||||||||
PostalCode: | 975045576 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5414140362 | ||||||||
FaxNumber: | 5412002269 | ||||||||
Practice Location | |||||||||
Address1: | 700 S MAIN ST | ||||||||
Address2: |   | ||||||||
City: | YREKA | ||||||||
State: | CA | ||||||||
PostalCode: | 960973354 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5414140362 | ||||||||
FaxNumber: | 5412002269 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/11/2019 | ||||||||
LastUpdateDate: | 02/20/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SINCLAIR | ||||||||
AuthorizedOfficialFirstName: | RACHELLE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 5414140362 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 02/20/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor |   |
No ID Information.