Provider Demographics
NPI:1740561927
Name:HIDDEN VALLEY CHIROPRACTIC
Entity Type:Organization
Organization Name:HIDDEN VALLEY CHIROPRACTIC
Other - Org Name:UPLAND CHIROPRACTIC AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:SANTIAGO
Authorized Official - Last Name:PONCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-582-9387
Mailing Address - Street 1:1675 HAMNER AVE
Mailing Address - Street 2:2
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-2973
Mailing Address - Country:US
Mailing Address - Phone:951-582-9387
Mailing Address - Fax:951-582-0916
Practice Address - Street 1:1675 HAMNER AVE
Practice Address - Street 2:2
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-2973
Practice Address - Country:US
Practice Address - Phone:951-582-9387
Practice Address - Fax:951-582-0916
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSE G. PONCE, DC CHIROPRACTOR, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26798111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU87511Medicare UPIN