Provider Demographics
NPI:1891970281
Name:RASSEL CHIRO CENTERS
Entity Type:Organization
Organization Name:RASSEL CHIRO CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:RASSEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-489-0303
Mailing Address - Street 1:330 W FELICITA AVE STE B1
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-6542
Mailing Address - Country:US
Mailing Address - Phone:760-489-0303
Mailing Address - Fax:760-489-0480
Practice Address - Street 1:330 W FELICITA AVE STE B1
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-6542
Practice Address - Country:US
Practice Address - Phone:760-489-0303
Practice Address - Fax:760-489-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11798111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC5544Medicare PIN