Provider Demographics
NPI:1154508141
Name:CHIROPRACTIC HEALTH CARE OF RSM
Entity Type:Organization
Organization Name:CHIROPRACTIC HEALTH CARE OF RSM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-459-9163
Mailing Address - Street 1:29839 SANTA MARGARITA PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3616
Mailing Address - Country:US
Mailing Address - Phone:949-459-9163
Mailing Address - Fax:949-459-2318
Practice Address - Street 1:29839 SANTA MARGARITA PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3616
Practice Address - Country:US
Practice Address - Phone:949-459-9163
Practice Address - Fax:949-459-2318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15243Medicare PIN