Provider Demographics
NPI:1548449739
Name:SOTTILE CHIROPRACTIC
Entity type:Organization
Organization Name:SOTTILE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTTILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-822-4386
Mailing Address - Street 1:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93581-0906
Mailing Address - Country:US
Mailing Address - Phone:661-822-4386
Mailing Address - Fax:661-823-1328
Practice Address - Street 1:777 W TEHACHAPI BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-1686
Practice Address - Country:US
Practice Address - Phone:661-822-4386
Practice Address - Fax:661-823-1328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0104320111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ79924ZMedicare PIN