Provider Demographics
NPI:1578928156
Name:MANSOUR CHIROPRACTIC GROUP, INC.
Entity Type:Organization
Organization Name:MANSOUR CHIROPRACTIC GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:RASHAD
Authorized Official - Middle Name:G
Authorized Official - Last Name:MANSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-916-0954
Mailing Address - Street 1:17050 BUSHARD ST STE 205
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2832
Mailing Address - Country:US
Mailing Address - Phone:714-916-0954
Mailing Address - Fax:
Practice Address - Street 1:17050 BUSHARD ST STE 205
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2832
Practice Address - Country:US
Practice Address - Phone:714-916-0954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NULUX MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32665111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty