Provider Demographics
NPI:1043797608
Name:VISICO CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:VISICO CHIROPRACTIC, INC.
Other - Org Name:MIRA MESA CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:VISICO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:858-453-0366
Mailing Address - Street 1:5850 OBERLIN DR STE 220
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4711
Mailing Address - Country:US
Mailing Address - Phone:858-453-0366
Mailing Address - Fax:858-453-0370
Practice Address - Street 1:5850 OBERLIN DR STE 220
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4711
Practice Address - Country:US
Practice Address - Phone:858-453-0366
Practice Address - Fax:858-453-0370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty