Provider Demographics
NPI:1457463796
Name:GANEM CHIROPRACTIC PROFESSIONAL CORP
Entity Type:Organization
Organization Name:GANEM CHIROPRACTIC PROFESSIONAL CORP
Other - Org Name:BODY PRO CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:EMILE
Authorized Official - Last Name:GANEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-552-5094
Mailing Address - Street 1:4482 BARRANCA PRKWY
Mailing Address - Street 2:# 192
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604
Mailing Address - Country:US
Mailing Address - Phone:949-552-5094
Mailing Address - Fax:949-552-5096
Practice Address - Street 1:4482 BARRANCA PRKWY
Practice Address - Street 2:# 192
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604
Practice Address - Country:US
Practice Address - Phone:949-552-5094
Practice Address - Fax:949-552-5096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC24373Medicare ID - Type Unspecified
DC24373Medicare UPIN