1194948067 NPI number — A PROFESSIONAL CHIROPRACTIC CORP.

Table of content: (NPI 1194948067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194948067 NPI number — A PROFESSIONAL CHIROPRACTIC CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A PROFESSIONAL CHIROPRACTIC CORP.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADVANCED BACK AND NECK CARE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194948067
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5220 CLARK AVE.
Provider Second Line Business Mailing Address:
SUITE 445
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-866-3340
Provider Business Mailing Address Fax Number:
562-804-0499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5220 CLARK AVE.
Provider Second Line Business Practice Location Address:
SUITE 445
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-866-3340
Provider Business Practice Location Address Fax Number:
562-804-0499
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VON BORSTEL
Authorized Official First Name:
EDWIN
Authorized Official Middle Name:
FREDERICK
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
562-866-3340

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  15417 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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