Provider Demographics
NPI:1790909059
Name:MARIO MOJICA CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:MARIO MOJICA CHIROPRACTIC INC.
Other - Org Name:WELLNESS FOR LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MOJICA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:858-274-2755
Mailing Address - Street 1:4141 JUTLAND DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-3662
Mailing Address - Country:US
Mailing Address - Phone:858-274-2755
Mailing Address - Fax:858-274-2710
Practice Address - Street 1:4141 JUTLAND DR
Practice Address - Street 2:SUITE 130
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-3662
Practice Address - Country:US
Practice Address - Phone:858-274-2755
Practice Address - Fax:858-274-2710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty