Provider Demographics
NPI:1154648533
Name:GUADAMUZ CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:GUADAMUZ CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:GUADAMUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-533-2214
Mailing Address - Street 1:1695 S SAN JACINTO AVE
Mailing Address - Street 2:STE. O
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-5103
Mailing Address - Country:US
Mailing Address - Phone:951-654-5900
Mailing Address - Fax:951-654-5933
Practice Address - Street 1:1695 S SAN JACINTO AVE
Practice Address - Street 2:STE. O
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5103
Practice Address - Country:US
Practice Address - Phone:951-654-5900
Practice Address - Fax:951-654-5933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0276040Medicare UPIN