Provider Demographics
NPI:1225189905
Name:CANDELARIO CHIROPRACTIC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CANDELARIO CHIROPRACTIC A PROFESSIONAL CORPORATION
Other - Org Name:RISE WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:RODEL
Authorized Official - Last Name:CANDELARIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-479-7473
Mailing Address - Street 1:5030 BONITA RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-1701
Mailing Address - Country:US
Mailing Address - Phone:619-479-7473
Mailing Address - Fax:619-479-9376
Practice Address - Street 1:5030 BONITA RD
Practice Address - Street 2:SUITE B
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-1701
Practice Address - Country:US
Practice Address - Phone:619-479-7473
Practice Address - Fax:619-479-9376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 28449111N00000X
CAAC 8793171100000X
225100000X, 225X00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV08093Medicare UPIN