Provider Demographics
NPI:1437554599
Name:SOUTH CORONA CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:SOUTH CORONA CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:VOGTSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-738-0660
Mailing Address - Street 1:2205 VESPER CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3501
Mailing Address - Country:US
Mailing Address - Phone:951-738-0660
Mailing Address - Fax:951-738-0102
Practice Address - Street 1:2205 VESPER CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3501
Practice Address - Country:US
Practice Address - Phone:951-738-0660
Practice Address - Fax:951-738-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC015460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPTAN DC0154160Medicare PIN