Provider Demographics
NPI:1174183362
Name:ANIMAL CHIROPRACTIC GROUP, INC.
Entity type:Organization
Organization Name:ANIMAL CHIROPRACTIC GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:IARED
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:559-681-7552
Mailing Address - Street 1:13540 E BULLARD AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-9458
Mailing Address - Country:US
Mailing Address - Phone:559-681-7552
Mailing Address - Fax:
Practice Address - Street 1:325 CLOVIS AVE STE 107
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-1151
Practice Address - Country:US
Practice Address - Phone:559-326-0546
Practice Address - Fax:888-651-4595
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANIMAL CHIROPRACTIC GROUP INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-19
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1750605325OtherNPI
CALICENSEOther31386 CA