Provider Demographics
NPI:1417027202
Name:ALESSANDRO CHIROPRACTIC
Entity Type:Organization
Organization Name:ALESSANDRO CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CORLEW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-247-4292
Mailing Address - Street 1:25400 ALESSANDRO BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-4319
Mailing Address - Country:US
Mailing Address - Phone:951-247-4292
Mailing Address - Fax:951-247-6632
Practice Address - Street 1:25400 ALESSANDRO BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-4319
Practice Address - Country:US
Practice Address - Phone:951-247-4292
Practice Address - Fax:951-247-6632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17455111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC017455Medicare ID - Type Unspecified