Provider Demographics
NPI:1679879878
Name:GEORGE LOUIS BALCARCEL CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:GEORGE LOUIS BALCARCEL CHIROPRACTIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:BALCARCEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-536-0733
Mailing Address - Street 1:14855 MONO WAY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-9252
Mailing Address - Country:US
Mailing Address - Phone:209-536-0733
Mailing Address - Fax:209-536-0741
Practice Address - Street 1:14855 MONO WAY
Practice Address - Street 2:SUITE 108
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-9252
Practice Address - Country:US
Practice Address - Phone:209-536-0733
Practice Address - Fax:209-536-0741
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGE LOUIS BALCARCEL CHIROPRACTIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-04
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8703436Medicaid
CADC0284540OtherMEDICARE ID-TYPE UNSPECIFIED
CAU95944Medicare UPIN