Provider Demographics
NPI:1619070091
Name:MIRANDA, STEVEN (DC)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 BROCKTON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3801
Mailing Address - Country:US
Mailing Address - Phone:951-788-9635
Mailing Address - Fax:951-788-9643
Practice Address - Street 1:6900 BROCKTON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3801
Practice Address - Country:US
Practice Address - Phone:951-788-9635
Practice Address - Fax:951-788-9643
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor