Provider Demographics
NPI:1679790653
Name:DETERS CHIROPRACTIC CORP
Entity type:Organization
Organization Name:DETERS CHIROPRACTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:DETERS
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:619-681-1919
Mailing Address - Street 1:2535 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 225
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3754
Mailing Address - Country:US
Mailing Address - Phone:619-681-1919
Mailing Address - Fax:619-681-1922
Practice Address - Street 1:2535 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 225
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3754
Practice Address - Country:US
Practice Address - Phone:619-681-1919
Practice Address - Fax:619-681-1922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20569111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU-70873Medicare UPIN