Provider Demographics
NPI:1629203757
Name:NOLAN CHIROPRACTIC INCORPORATED
Entity Type:Organization
Organization Name:NOLAN CHIROPRACTIC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-633-5521
Mailing Address - Street 1:15550 ROCKFIELD BLVD
Mailing Address - Street 2:B220
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2720
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:438 E KATELLA AVE
Practice Address - Street 2:SUITE L
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-4839
Practice Address - Country:US
Practice Address - Phone:714-633-5521
Practice Address - Fax:714-633-8766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24771111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1972632412OtherINDIVIDUAL NPI
CADC24771OtherCHIROPRACTIC LICENSE