Provider Demographics
NPI:1518399757
Name:GASPER CHIROPRACTIC PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:GASPER CHIROPRACTIC PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GASPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:657-464-9123
Mailing Address - Street 1:17050 BUSHARD ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2832
Mailing Address - Country:US
Mailing Address - Phone:657-464-9123
Mailing Address - Fax:714-274-9806
Practice Address - Street 1:17050 BUSHARD ST
Practice Address - Street 2:SUITE 205
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2832
Practice Address - Country:US
Practice Address - Phone:657-464-9123
Practice Address - Fax:714-274-9806
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GASPER CHIROPRACTIC PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26507111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty