Provider Demographics
NPI:1083778419
Name:PRESTON LE CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:PRESTON LE CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:PHU
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-863-8808
Mailing Address - Street 1:9361 BOLSA AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5953
Mailing Address - Country:US
Mailing Address - Phone:714-863-8808
Mailing Address - Fax:714-775-7590
Practice Address - Street 1:9361 BOLSA AVE STE 104
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5953
Practice Address - Country:US
Practice Address - Phone:714-863-8808
Practice Address - Fax:714-775-7590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD.C.27797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD.C.27797Medicare UPIN