Provider Demographics
NPI:1790018695
Name:WARREN CHIROPRACTIC HEALTH CENTER, A PROF CORP
Entity Type:Organization
Organization Name:WARREN CHIROPRACTIC HEALTH CENTER, A PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-963-0955
Mailing Address - Street 1:17931 EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5409
Mailing Address - Country:US
Mailing Address - Phone:714-963-0955
Mailing Address - Fax:714-963-5775
Practice Address - Street 1:10956 WARNER AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3853
Practice Address - Country:US
Practice Address - Phone:714-963-0955
Practice Address - Fax:714-963-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22886111N00000X
CADC22944111N00000X
CAPT11954225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty