Provider Demographics
NPI:1023495686
Name:CRUSADE SPECIFIC CHIROPRACTIC
Entity type:Organization
Organization Name:CRUSADE SPECIFIC CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:CRUSADE
Authorized Official - Last Name:GARAVELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-442-7474
Mailing Address - Street 1:903 30TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4407
Mailing Address - Country:US
Mailing Address - Phone:916-442-7474
Mailing Address - Fax:916-442-7477
Practice Address - Street 1:903 30TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4407
Practice Address - Country:US
Practice Address - Phone:916-442-7474
Practice Address - Fax:916-442-7477
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRUSADE SPECIFIC CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA268570111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty