Provider Demographics
NPI:1598097446
Name:SURACE'S CHIROPRACTIC BACK ALERT CLINIC
Entity Type:Organization
Organization Name:SURACE'S CHIROPRACTIC BACK ALERT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:SURACE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-547-5691
Mailing Address - Street 1:819 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-3508
Mailing Address - Country:US
Mailing Address - Phone:714-547-5691
Mailing Address - Fax:714-547-5694
Practice Address - Street 1:819 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-3508
Practice Address - Country:US
Practice Address - Phone:714-547-5691
Practice Address - Fax:714-547-5694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10283111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty