Provider Demographics
NPI:1659696748
Name:PORATH, WILLIAM T (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:T
Last Name:PORATH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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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 1:1748 W KATELLA AVE
Practice Address - Street 2:107
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-3437
Practice Address - Country:US
Practice Address - Phone:714-313-4212
Practice Address - Fax:714-464-5365
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2014-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CADC26124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC26124OtherD.C. LICENSE
CAZZZ03106ZOtherBLUE SHIELD
CA1366767451OtherGROUP NPI