Provider Demographics
NPI:1457002396
Name:DR. NELSON SANTOS CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:DR. NELSON SANTOS CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-621-8224
Mailing Address - Street 1:100 W HIGH ST # 748
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-1113
Mailing Address - Country:US
Mailing Address - Phone:805-531-1188
Mailing Address - Fax:805-531-1112
Practice Address - Street 1:530 NEW LOS ANGELES AVE STE 210
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-2089
Practice Address - Country:US
Practice Address - Phone:805-531-1188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty