Provider Demographics
NPI:1689877987
Name:INLAND VALLEY REHABILITATION
Entity Type:Organization
Organization Name:INLAND VALLEY REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:SHUKUE
Authorized Official - Last Name:KONO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:909-946-2673
Mailing Address - Street 1:886 W FOOTHILL BLVD
Mailing Address - Street 2:STE. E
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3769
Mailing Address - Country:US
Mailing Address - Phone:909-946-2673
Mailing Address - Fax:909-946-1872
Practice Address - Street 1:886 W FOOTHILL BLVD
Practice Address - Street 2:STE. E
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3769
Practice Address - Country:US
Practice Address - Phone:909-946-2673
Practice Address - Fax:909-946-1872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0254590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0254590Medicare ID - Type UnspecifiedMEDICARE NUMBER