Provider Demographics
NPI:1063683373
Name:MANSOUR CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:MANSOUR CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:MANSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:909-393-4545
Mailing Address - Street 1:14740 PIPELINE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1293
Mailing Address - Country:US
Mailing Address - Phone:909-393-4545
Mailing Address - Fax:909-393-3899
Practice Address - Street 1:14740 PIPELINE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1293
Practice Address - Country:US
Practice Address - Phone:909-393-4545
Practice Address - Fax:909-393-3899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20299111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty