Provider Demographics
NPI:1639331507
Name:S & G CHIROPRACTIC GROUP
Entity Type:Organization
Organization Name:S & G CHIROPRACTIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-270-2883
Mailing Address - Street 1:1810 FULLERTON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-3104
Mailing Address - Country:US
Mailing Address - Phone:951-270-2883
Mailing Address - Fax:951-270-2886
Practice Address - Street 1:1810 FULLERTON AVE STE 201
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3104
Practice Address - Country:US
Practice Address - Phone:951-270-2883
Practice Address - Fax:951-270-2886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty