Provider Demographics
NPI:1275979577
Name:BOUWHUIS CHIROPRACTIC CORP
Entity Type:Organization
Organization Name:BOUWHUIS CHIROPRACTIC CORP
Other - Org Name:THERAPY SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOUWHUIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-487-2722
Mailing Address - Street 1:24582 DEL PRADO STE H
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3821
Mailing Address - Country:US
Mailing Address - Phone:949-487-2722
Mailing Address - Fax:949-487-2723
Practice Address - Street 1:24582 DEL PRADO STE H
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3821
Practice Address - Country:US
Practice Address - Phone:949-487-2722
Practice Address - Fax:949-487-2723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31527111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
45-1538580OtherFORMER NPI (WHEN PRACTICED AS SOLE PROPRIETOR)
CACA-31527OtherLICENSE TO PRACTICE CHIROPRACTIC