Provider Demographics
NPI:1407047541
Name:LAGUNA NIGUEL CHIROPRACTIC
Entity Type:Organization
Organization Name:LAGUNA NIGUEL CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SPEARE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-495-2843
Mailing Address - Street 1:30101 TOWN CENTER DR
Mailing Address - Street 2:SUITE112
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-5006
Mailing Address - Country:US
Mailing Address - Phone:949-495-2843
Mailing Address - Fax:949-495-3746
Practice Address - Street 1:30101 TOWN CENTER DR
Practice Address - Street 2:SUITE112
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-5006
Practice Address - Country:US
Practice Address - Phone:949-495-2843
Practice Address - Fax:949-495-3746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14245111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADEC14245Medicare PIN