Provider Demographics
NPI:1497247050
Name:CHAN CHIROPRACTIC HEALTHCARE PLACE INC
Entity Type:Organization
Organization Name:CHAN CHIROPRACTIC HEALTHCARE PLACE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN PLACE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:909-991-5888
Mailing Address - Street 1:1235 N HARBOR BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1323
Mailing Address - Country:US
Mailing Address - Phone:714-871-9080
Mailing Address - Fax:
Practice Address - Street 1:7354 PAINTER AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1853
Practice Address - Country:US
Practice Address - Phone:562-789-1999
Practice Address - Fax:562-789-1995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-30
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28634111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty