Provider Demographics
NPI:1710206040
Name:MORELLO FAMILY CHIROPRACTIC, INC
Entity type:Organization
Organization Name:MORELLO FAMILY CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:650-225-9900
Mailing Address - Street 1:1177 MISSION RD STE C
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-7702
Mailing Address - Country:US
Mailing Address - Phone:650-225-9900
Mailing Address - Fax:
Practice Address - Street 1:1177 MISSION RD STE C
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-7702
Practice Address - Country:US
Practice Address - Phone:650-225-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29332111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty