Provider Demographics
NPI:1295000636
Name:ESCOBEDO CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:ESCOBEDO CHIROPRACTIC INC.
Other - Org Name:COAST FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROD
Authorized Official - Middle Name:J
Authorized Official - Last Name:ESCOBEDO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-722-7572
Mailing Address - Street 1:179 E 17TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3724
Mailing Address - Country:US
Mailing Address - Phone:949-722-7572
Mailing Address - Fax:949-722-7603
Practice Address - Street 1:179 E 17TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3724
Practice Address - Country:US
Practice Address - Phone:949-722-7572
Practice Address - Fax:949-722-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty