Provider Demographics
NPI:1609416635
Name:GUEDEA CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:GUEDEA CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:GUEDEA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-317-3053
Mailing Address - Street 1:302 W 5TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-2700
Mailing Address - Country:US
Mailing Address - Phone:310-732-0029
Mailing Address - Fax:310-732-0039
Practice Address - Street 1:302 W 5TH ST STE 101
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-2700
Practice Address - Country:US
Practice Address - Phone:310-732-0029
Practice Address - Fax:310-732-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty