Provider Demographics
NPI:1861607947
Name:SIDHU, PRITPAL S (DC)
Entity type:Individual
Prefix:DR
First Name:PRITPAL
Middle Name:S
Last Name:SIDHU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 W HOSPITALITY LN
Mailing Address - Street 2:20
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3334
Mailing Address - Country:US
Mailing Address - Phone:909-890-0079
Mailing Address - Fax:
Practice Address - Street 1:165 W HOSPITALITY LN
Practice Address - Street 2:20
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3334
Practice Address - Country:US
Practice Address - Phone:909-890-0079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22855111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor