Provider Demographics
NPI:1548599145
Name:PENINSULA SPINE & SPORTS REHAB, A ROMMEL HINDOCHA CHIROPRACTIC CORP.
Entity Type:Organization
Organization Name:PENINSULA SPINE & SPORTS REHAB, A ROMMEL HINDOCHA CHIROPRACTIC CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMMEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HINDOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:650-347-2225
Mailing Address - Street 1:101 S SAN MATEO DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3819
Mailing Address - Country:US
Mailing Address - Phone:650-347-2225
Mailing Address - Fax:650-242-8802
Practice Address - Street 1:101 S SAN MATEO DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3819
Practice Address - Country:US
Practice Address - Phone:650-347-2225
Practice Address - Fax:650-242-8802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-28240111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty