Provider Demographics
NPI:1063860591
Name:CONNOR UPPER CERVICAL CHIROPRACTIC OF SOUTHERN CALIFORNIA
Entity Type:Organization
Organization Name:CONNOR UPPER CERVICAL CHIROPRACTIC OF SOUTHERN CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:CONOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-642-5660
Mailing Address - Street 1:485 E 17TH ST STE 510
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-4719
Mailing Address - Country:US
Mailing Address - Phone:949-642-5660
Mailing Address - Fax:
Practice Address - Street 1:485 E 17TH ST STE 510
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-4719
Practice Address - Country:US
Practice Address - Phone:949-642-5660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25423111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty