Provider Demographics
NPI:1750640074
Name:SAN DIEGO SPINAL CARE
Entity Type:Organization
Organization Name:SAN DIEGO SPINAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:KENNA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-631-5433
Mailing Address - Street 1:6370 LUSK BLVD
Mailing Address - Street 2:F205
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2753
Mailing Address - Country:US
Mailing Address - Phone:619-631-5433
Mailing Address - Fax:
Practice Address - Street 1:6370 LUSK BLVD
Practice Address - Street 2:F205
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2753
Practice Address - Country:US
Practice Address - Phone:619-631-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32051111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty