Organization
AMBRIDGE CHIROPRACTIC CORP
Active
Other names
Santa Rosa Chiropractic Neurology Center
Organization subpart
No
Provider details
NPI number
Authorized official
FOREST BLAKE AMBRIDGE (OWNER)
(707) 575-9009
Entity
Organization
Contact information
Practice address
990 SONOMA AVE STE 18, SANTA ROSA, CA 95404-4813
(707) 575-9009
(707) 575-4267
Mailing address
3540 MENDOCINO AVE, #300, SANTA ROSA, CA 95403-2276
(707) 575-9009
(707) 575-4267
Taxonomy
Speciality
Code
Description
License number
State
111NN0400X
Neurology Chiropractor
Primary
19037
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ04893Z
BLUE SHIELD PROVIDER
CA
Enumeration date
07/04/2006
Last updated
05/14/2019
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