Provider Demographics
NPI:1891056925
Name:ANJANETTE M WELIKALA CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:ANJANETTE M WELIKALA CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANJANETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WELIKALA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-443-4500
Mailing Address - Street 1:15550 ROCKFIELD BLVD
Mailing Address - Street 2:B220
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2720
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:45 W LOS ANGELES AVE
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-1820
Practice Address - Country:US
Practice Address - Phone:805-443-4500
Practice Address - Fax:805-523-9630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0273730OtherBLUE SHIELD INDIVIDUAL PIN
CACHIROPRACTIC LICENSEOtherDC27373