Organization
NATOMA STATION CHIROPRACTIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DENNIS M WAZAC DC (OWNER)
(916) 985-7575
Entity
Organization
Contact information
Practice address
231 BLUE RAVINE RD, SUITE 200, FOLSOM, CA 95630-3893
(916) 985-7575
Mailing address
231 BLUE RAVINE RD, SUITE 200, FOLSOM, CA 95630-3893
(916) 985-7575
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
DC26511
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ62244Z
BLUE SHIELD OF CALIFORNIA
—
Enumeration date
03/29/2008
Last updated
03/29/2008
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