Provider Demographics
NPI:1760652051
Name:GRECIAN CHIROPRACTIC AND WELLNESS
Entity Type:Organization
Organization Name:GRECIAN CHIROPRACTIC AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:PIERSON
Authorized Official - Last Name:GRECIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-548-3818
Mailing Address - Street 1:1901 NEWPORT BLVD
Mailing Address - Street 2:SUIT 185
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2278
Mailing Address - Country:US
Mailing Address - Phone:949-548-3818
Mailing Address - Fax:949-548-3821
Practice Address - Street 1:1901 NEWPORT BLVD
Practice Address - Street 2:SUIT 185
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2278
Practice Address - Country:US
Practice Address - Phone:949-548-3818
Practice Address - Fax:949-548-3821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27603111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty