Provider Demographics
NPI:1891844346
Name:CHULA VISTA PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CHULA VISTA PROFESSIONAL CORPORATION
Other - Org Name:CHIROPRACTIC USA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-818-7788
Mailing Address - Street 1:1171 E RANCHO VISTOSO BLVD
Mailing Address - Street 2:SUITE 123
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-9107
Mailing Address - Country:US
Mailing Address - Phone:520-818-7788
Mailing Address - Fax:520-818-1648
Practice Address - Street 1:1171 E RANCHO VISTOSO BLVD
Practice Address - Street 2:SUITE 123
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-9107
Practice Address - Country:US
Practice Address - Phone:520-818-7788
Practice Address - Fax:520-818-1648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7236111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty