Provider Demographics
NPI:1750847562
Name:SPECTRUM CHIROPRACTIC AN OCHOA-REA CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:SPECTRUM CHIROPRACTIC AN OCHOA-REA CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:GERARDO
Authorized Official - Last Name:OCHOA-REA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-300-3838
Mailing Address - Street 1:3069 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-3030
Mailing Address - Country:US
Mailing Address - Phone:619-300-3838
Mailing Address - Fax:
Practice Address - Street 1:3069 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-3030
Practice Address - Country:US
Practice Address - Phone:619-300-3838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-17
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty