Provider Demographics
NPI:1407139041
Name:TAGLEWELLNESS
Entity Type:Organization
Organization Name:TAGLEWELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:ALEJANDRO
Authorized Official - Last Name:TAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-769-1807
Mailing Address - Street 1:2000 CORPORATE DR
Mailing Address - Street 2:#402
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1104
Mailing Address - Country:US
Mailing Address - Phone:949-769-1807
Mailing Address - Fax:
Practice Address - Street 1:1847 XIMENO AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-2850
Practice Address - Country:US
Practice Address - Phone:562-498-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCO A TAGLE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25937111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty