Provider Demographics
NPI:1326016197
Name:VIRAG, JOHN ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALLEN
Last Name:VIRAG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 CAMINO DE LOS MARES
Mailing Address - Street 2:#134 DEL MAR CHIROPRACTIC
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673
Mailing Address - Country:US
Mailing Address - Phone:949-492-1332
Mailing Address - Fax:949-492-5975
Practice Address - Street 1:657 CAMINO DE LOS MARES
Practice Address - Street 2:#134 DEL MAR CHIROPRACTIC
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673
Practice Address - Country:US
Practice Address - Phone:949-492-1332
Practice Address - Fax:949-492-5975
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU18500Medicare UPIN
CADC17371Medicare ID - Type Unspecified