Provider Demographics
NPI:1336697507
Name:RON COTTRELL AND ANTHONY WERBELOW CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:RON COTTRELL AND ANTHONY WERBELOW CHIROPRACTIC CORPORATION
Other - Org Name:ACTIVE MOBILITY CHIROPRACTIC REHABILITATION GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:STEVENS
Authorized Official - Last Name:COTTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-599-4900
Mailing Address - Street 1:1680 S MELROSE DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-5472
Mailing Address - Country:US
Mailing Address - Phone:760-599-4900
Mailing Address - Fax:760-599-9037
Practice Address - Street 1:1680 S MELROSE DR
Practice Address - Street 2:SUITE 105
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-5472
Practice Address - Country:US
Practice Address - Phone:760-599-4900
Practice Address - Fax:760-599-9037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty