Provider Demographics
NPI:1073846820
Name:DESIGNER HEALTH AND REHAB MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DESIGNER HEALTH AND REHAB MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:PROF
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SOLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-660-8936
Mailing Address - Street 1:11024 BALBOA BLVD # 504
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-5007
Mailing Address - Country:US
Mailing Address - Phone:818-363-3000
Mailing Address - Fax:818-363-3099
Practice Address - Street 1:17777 MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-4795
Practice Address - Country:US
Practice Address - Phone:949-660-8936
Practice Address - Fax:949-660-1512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15396111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15396OtherLICENSE