Provider Demographics
NPI:1629349634
Name:MIRANDA, APOLINAR (DC)
Entity Type:Individual
Prefix:DR
First Name:APOLINAR
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:POL
Other - Middle Name:
Other - Last Name:MIRANDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:16862 HOSKINS LN
Mailing Address - Street 2:#3
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-3933
Mailing Address - Country:US
Mailing Address - Phone:609-457-7931
Mailing Address - Fax:
Practice Address - Street 1:532 REDONDO AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90814-1552
Practice Address - Country:US
Practice Address - Phone:562-439-0419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32163111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor