1043605504 NPI number — GLASS VELICHKO CHIROPRACTIC P.C.

Table of content: (NPI 1043605504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043605504 NPI number — GLASS VELICHKO CHIROPRACTIC P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLASS VELICHKO CHIROPRACTIC P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE SHIFT CHIROPRACTIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043605504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
435 8TH ST
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94607-3963
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-858-5370
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
435 8TH ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94607-3963
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-858-5370
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2015

Additional Information

Authorized Official

Authorized Official Last Name:
VELICHKO
Authorized Official First Name:
IRINA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIROPRACTOR/VICE PRESIDENT/CO-OWNE
Authorized Official Telephone Number:
510-858-5370

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  32669 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 33186 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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