Provider Demographics
NPI:1205005402
Name:GARCIA, OMAR (DC)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32246 CLINTON KEITH RD
Mailing Address - Street 2:STE 102
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7320
Mailing Address - Country:US
Mailing Address - Phone:951-678-9063
Mailing Address - Fax:
Practice Address - Street 1:32246 CLINTON KEITH RD
Practice Address - Street 2:STE 102
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7320
Practice Address - Country:US
Practice Address - Phone:951-678-9063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor