Provider Demographics
NPI:1427382209
Name:GEORGE UJKIC CHIROPRACTIC PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:GEORGE UJKIC CHIROPRACTIC PROFESSIONAL CORPORATION
Other - Org Name:CHIROPRACTIC CENTER OF ORANGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:N
Authorized Official - Last Name:UJKIC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-639-3935
Mailing Address - Street 1:630 S GLASSELL ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-3004
Mailing Address - Country:US
Mailing Address - Phone:714-639-3935
Mailing Address - Fax:
Practice Address - Street 1:630 S GLASSELL ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-3004
Practice Address - Country:US
Practice Address - Phone:714-639-3935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC20015OtherLICENSE