Provider Demographics
NPI:1588037485
Name:BUENA PARK CHIROPRACTIC INC
Entity Type:Organization
Organization Name:BUENA PARK CHIROPRACTIC INC
Other - Org Name:NULUX MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:RASHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-527-3332
Mailing Address - Street 1:8821 VALLEY VIEW ST
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-3528
Mailing Address - Country:US
Mailing Address - Phone:714-527-3332
Mailing Address - Fax:714-527-3313
Practice Address - Street 1:8821 VALLEY VIEW ST
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-3528
Practice Address - Country:US
Practice Address - Phone:714-527-3332
Practice Address - Fax:714-527-3313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32665111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty