Provider Demographics
NPI:1033555602
Name:ANTHONY BECERRA MANAGEMENT COMPANY
Entity Type:Organization
Organization Name:ANTHONY BECERRA MANAGEMENT COMPANY
Other - Org Name:PURE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BECERRA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-461-4617
Mailing Address - Street 1:25136 HANCOCK AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-0905
Mailing Address - Country:US
Mailing Address - Phone:951-461-4617
Mailing Address - Fax:951-461-1403
Practice Address - Street 1:25136 HANCOCK AVE STE C
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-0905
Practice Address - Country:US
Practice Address - Phone:951-461-4617
Practice Address - Fax:951-461-1403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 26181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty