Provider Demographics
NPI:1548745862
Name:VANDERSCHELDEN MOMMA CHIROPRACTIC PC
Entity Type:Organization
Organization Name:VANDERSCHELDEN MOMMA CHIROPRACTIC PC
Other - Org Name:MOMMA'S CHIRO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERSCHELDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-794-2171
Mailing Address - Street 1:18600 MAIN ST STE 110
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1715
Mailing Address - Country:US
Mailing Address - Phone:714-794-2171
Mailing Address - Fax:
Practice Address - Street 1:18600 MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1715
Practice Address - Country:US
Practice Address - Phone:714-794-2171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-02
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Multi-Specialty