Provider Demographics
NPI:1245603927
Name:CORONADO ISLAND CHIROPRACTIC
Entity Type:Organization
Organization Name:CORONADO ISLAND CHIROPRACTIC
Other - Org Name:CORONADO ISLAND CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:V
Authorized Official - Last Name:GARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-865-1053
Mailing Address - Street 1:1001 B AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-3425
Mailing Address - Country:US
Mailing Address - Phone:619-865-1053
Mailing Address - Fax:
Practice Address - Street 1:1001 B AVE STE 308
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-3425
Practice Address - Country:US
Practice Address - Phone:619-865-1053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty