Provider Demographics
NPI:1760821334
Name:MANSOUR, RASHAD G (DC)
Entity Type:Individual
Prefix:DR
First Name:RASHAD
Middle Name:G
Last Name:MANSOUR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17050 BUSHARD ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708
Mailing Address - Country:US
Mailing Address - Phone:714-916-0954
Mailing Address - Fax:
Practice Address - Street 1:17050 BUSHARD ST STE 205
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2832
Practice Address - Country:US
Practice Address - Phone:714-916-0954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32665111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor