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Healthcare Organization Stored source record

LORI ANDREIS BERGERON

1640 TIBURON BLVD, 6, TIBURON, CA, 949202515

atlas:atm_npi_1104038777

Block 3020Block Group 3Census Tract 1242Marin CountyCaliforniaUnited States

What is stored

phone
415-435-7420
status
A
address
1640 TIBURON BLVD, 6, TIBURON, CA, 949202515
fax
415-435-7424
npi
1104038777
license
DC21875
taxonomy
Chiropractor
other names
["TIBURON WELLNESS CENTER"]
last updated
2007-07-25
license state
CA
taxonomy code
111N00000X
all taxonomies
["Chiropractor","Chiropractor"]
enumeration date
2007-05-04
enumeration type
NPI-2
practice locations
0
authorized official
GRETCHEN ANDREIS
organizational subpart
NO

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{
  "fax": "415-435-7424",
  "npi": "1104038777",
  "phone": "415-435-7420",
  "status": "A",
  "address": "1640 TIBURON BLVD, 6, TIBURON, CA, 949202515",
  "license": "DC21875",
  "taxonomy": "Chiropractor",
  "other_names": [
    "TIBURON WELLNESS CENTER"
  ],
  "last_updated": "2007-07-25",
  "license_state": "CA",
  "taxonomy_code": "111N00000X",
  "all_taxonomies": [
    "Chiropractor",
    "Chiropractor"
  ],
  "enumeration_date": "2007-05-04",
  "enumeration_type": "NPI-2",
  "practice_locations": 0,
  "authorized_official": "GRETCHEN ANDREIS",
  "organizational_subpart": "NO"
}