Provider Demographics
NPI:1518254267
Name:CHIROPRACTICE HEALTH CARE OF RANCHO SANTA MARGARITA
Entity Type:Organization
Organization Name:CHIROPRACTICE HEALTH CARE OF RANCHO SANTA MARGARITA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-459-9163
Mailing Address - Street 1:PO BOX 80005
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-0005
Mailing Address - Country:US
Mailing Address - Phone:949-459-9163
Mailing Address - Fax:949-459-2318
Practice Address - Street 1:29851 AVENTURA STE M
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2014
Practice Address - Country:US
Practice Address - Phone:949-459-9163
Practice Address - Fax:949-459-2318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15243Medicare PIN