Provider Demographics
NPI:1518038298
Name:KENT A SVENINGSON A CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:KENT A SVENINGSON A CHIROPRACTIC CORPORATION
Other - Org Name:SVENINGSON CHIROPRACTIC INC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SVENINGSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-376-3030
Mailing Address - Street 1:1100 S COAST HWY
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2968
Mailing Address - Country:US
Mailing Address - Phone:949-376-3030
Mailing Address - Fax:949-376-3028
Practice Address - Street 1:1100 S COAST HWY
Practice Address - Street 2:SUITE 215
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2968
Practice Address - Country:US
Practice Address - Phone:949-376-3030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC 21528Medicare PIN
CADC21528Medicare ID - Type Unspecified