Provider Demographics
NPI:1619202017
Name:PRIME CHIROPRACTIC GROUP
Entity Type:Organization
Organization Name:PRIME CHIROPRACTIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:HOMAYOUN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HAMIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-863-6196
Mailing Address - Street 1:6244 EL CAJON BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-3918
Mailing Address - Country:US
Mailing Address - Phone:619-326-0606
Mailing Address - Fax:619-326-0626
Practice Address - Street 1:6244 EL CAJON BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-3918
Practice Address - Country:US
Practice Address - Phone:619-326-0606
Practice Address - Fax:619-326-0626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty