Provider Demographics
NPI:1700962198
Name:HUEY CHIROPRACTIC, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:HUEY CHIROPRACTIC, A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HUEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-967-5088
Mailing Address - Street 1:7816 UPLANDS WAY
Mailing Address - Street 2:STE. A
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7568
Mailing Address - Country:US
Mailing Address - Phone:916-967-5088
Mailing Address - Fax:916-967-5089
Practice Address - Street 1:7816 UPLANDS WAY
Practice Address - Street 2:STE. A
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7568
Practice Address - Country:US
Practice Address - Phone:916-967-5088
Practice Address - Fax:916-967-5089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV05108Medicare UPIN
CADC0297060Medicare PIN