Provider Demographics
NPI:1457666182
Name:CHIROREHAB INC
Entity Type:Organization
Organization Name:CHIROREHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMIEN
Authorized Official - Middle Name:JOHANN
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-631-6432
Mailing Address - Street 1:425 OLD NEWPORT BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4250
Mailing Address - Country:US
Mailing Address - Phone:949-631-6432
Mailing Address - Fax:949-258-5858
Practice Address - Street 1:425 OLD NEWPORT BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4250
Practice Address - Country:US
Practice Address - Phone:949-631-6432
Practice Address - Fax:949-258-5858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31139111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty