Provider Demographics
NPI:1871752667
Name:ROMAN R HYSELL CHIROPRACTIC INC
Entity type:Organization
Organization Name:ROMAN R HYSELL CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:RON
Authorized Official - Last Name:HYSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:559-875-3535
Mailing Address - Street 1:2216 JENSEN AVE
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-2232
Mailing Address - Country:US
Mailing Address - Phone:559-875-3535
Mailing Address - Fax:559-875-2337
Practice Address - Street 1:2216 JENSEN AVE
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-2232
Practice Address - Country:US
Practice Address - Phone:559-875-3535
Practice Address - Fax:559-875-2337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0300250Medicare PIN
CAV08676Medicare UPIN