Provider Demographics
NPI:1093038770
Name:BELLWOOD CHIROPRACTIC
Entity Type:Organization
Organization Name:BELLWOOD CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:SHARON
Authorized Official - Last Name:BELLWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:909-941-0633
Mailing Address - Street 1:8645 HAVEN AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4818
Mailing Address - Country:US
Mailing Address - Phone:909-941-0633
Mailing Address - Fax:909-945-5372
Practice Address - Street 1:8645 HAVEN AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4818
Practice Address - Country:US
Practice Address - Phone:909-941-0633
Practice Address - Fax:909-945-5372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18328111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty