Provider Demographics
NPI:1326108788
Name:LOPEZ, LUIS ENRIQUE (DC)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ENRIQUE
Last Name:LOPEZ
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 1:73744 HIGHWAY 111 STE 7
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4011
Mailing Address - Country:US
Mailing Address - Phone:760-776-9862
Mailing Address - Fax:760-776-9864
Practice Address - Street 1:73744 HIGHWAY 111 STE 7
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4011
Practice Address - Country:US
Practice Address - Phone:760-776-9862
Practice Address - Fax:760-776-9864
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor