Provider Demographics
NPI:1821044934
Name:MISSION CHIROPRACTIC
Entity Type:Organization
Organization Name:MISSION CHIROPRACTIC
Other - Org Name:SCHMELTZER TEITELBAUM CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SECRETARY OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIRI
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-215-4000
Mailing Address - Street 1:27405 PUERTA REAL
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691
Mailing Address - Country:US
Mailing Address - Phone:949-215-4000
Mailing Address - Fax:949-215-4500
Practice Address - Street 1:27405 PUERTA REAL
Practice Address - Street 2:SUITE 350
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-215-4000
Practice Address - Fax:949-215-4500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16702Medicare ID - Type Unspecified