Provider Demographics
NPI:1275913667
Name:MOJAVE CHIROPRACTIC
Entity Type:Organization
Organization Name:MOJAVE CHIROPRACTIC
Other - Org Name:ARROW CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-952-3800
Mailing Address - Street 1:15000 SEVENTH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-3852
Mailing Address - Country:US
Mailing Address - Phone:760-952-3800
Mailing Address - Fax:760-245-9754
Practice Address - Street 1:15000 SEVENTH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3852
Practice Address - Country:US
Practice Address - Phone:760-952-3800
Practice Address - Fax:760-245-9754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty