Provider Demographics
NPI:1407188964
Name:SEBASTIAN GONZALES CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:SEBASTIAN GONZALES CHIROPRACTIC INC.
Other - Org Name:ORANGE COUNTY PAIN MANAGEMENT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEBASTIAN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:714-502-4243
Mailing Address - Street 1:7415 SEASTAR DR UNIT 8
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2275
Mailing Address - Country:US
Mailing Address - Phone:714-502-4243
Mailing Address - Fax:
Practice Address - Street 1:17931 BEACH BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7113
Practice Address - Country:US
Practice Address - Phone:714-502-4243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty