Provider Demographics
NPI:1083726129
Name:POWER, CHRISTOPHER WALLACE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:WALLACE
Last Name:POWER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:CHRIS
Other - Middle Name:W
Other - Last Name:POWER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1371 LONGWOOD PINES LN
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-4070
Mailing Address - Country:US
Mailing Address - Phone:951-279-7542
Mailing Address - Fax:
Practice Address - Street 1:268 N LINCOLN AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-7164
Practice Address - Country:US
Practice Address - Phone:951-735-3223
Practice Address - Fax:951-735-3773
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 28841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA34-2050479OtherEIN
CA34-2050479OtherEIN
CAV 00217Medicare UPIN