Provider Demographics
NPI:1689066904
Name:BODY MECHANICS, WALSH CHIROPRACTIC AND SPORTS THERAPY
Entity Type:Organization
Organization Name:BODY MECHANICS, WALSH CHIROPRACTIC AND SPORTS THERAPY
Other - Org Name:MILLER FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-540-1710
Mailing Address - Street 1:3151 AIRWAY AVE
Mailing Address - Street 2:SUITE K103
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4607
Mailing Address - Country:US
Mailing Address - Phone:714-540-1710
Mailing Address - Fax:714-540-3191
Practice Address - Street 1:3151 AIRWAY AVE
Practice Address - Street 2:SUITE K103
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4607
Practice Address - Country:US
Practice Address - Phone:714-540-1710
Practice Address - Fax:714-540-3191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32523111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB208392OtherPTAN
CADC32523OtherLICENSE
CACB208392OtherPTAN