Provider Demographics
NPI:1558540757
Name:CARMELITA LOPEZ-MITCHELL A CHIROPRACTIC CORP.
Entity Type:Organization
Organization Name:CARMELITA LOPEZ-MITCHELL A CHIROPRACTIC CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARMELITA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ-MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-489-7762
Mailing Address - Street 1:325 W 3RD AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4140
Mailing Address - Country:US
Mailing Address - Phone:760-489-7760
Mailing Address - Fax:760-737-9865
Practice Address - Street 1:325 W 3RD AVE STE 106
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4140
Practice Address - Country:US
Practice Address - Phone:760-489-7760
Practice Address - Fax:760-737-9865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18861261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC18861AMedicare PIN