Provider Demographics
NPI:1871711176
Name:BAINER CHIROPRACTIC INC.
Entity type:Organization
Organization Name:BAINER CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BAINER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-962-3088
Mailing Address - Street 1:5006 SUNRISE BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-4940
Mailing Address - Country:US
Mailing Address - Phone:916-962-3088
Mailing Address - Fax:
Practice Address - Street 1:5006 SUNRISE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-4940
Practice Address - Country:US
Practice Address - Phone:916-962-3088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24877111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1831114024OtherTYPE 1 NPI (INDIVIDUAL)
CADC0248770Medicare ID - Type Unspecified