Provider Demographics
NPI:1568813632
Name:BOTELHO CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:BOTELHO CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMANUEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:BOTELHO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-862-7499
Mailing Address - Street 1:18017 SKY PARK CIR STE F
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6579
Mailing Address - Country:US
Mailing Address - Phone:949-862-7499
Mailing Address - Fax:949-862-7496
Practice Address - Street 1:18017 SKY PARK CIR STE F
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6579
Practice Address - Country:US
Practice Address - Phone:949-862-7499
Practice Address - Fax:949-862-7496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty