Provider Demographics
NPI:1639208804
Name:FLORES, DAVID CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHARLES
Last Name:FLORES
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 1:10412 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAMONT
Mailing Address - State:CA
Mailing Address - Zip Code:93241-1727
Mailing Address - Country:US
Mailing Address - Phone:661-845-1188
Mailing Address - Fax:661-845-2448
Practice Address - Street 1:10412 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAMONT
Practice Address - State:CA
Practice Address - Zip Code:93241-1727
Practice Address - Country:US
Practice Address - Phone:661-845-1188
Practice Address - Fax:661-845-2448
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18796111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU25801Medicare UPIN
CADC0187960Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION #