Provider Demographics
NPI:1912028663
Name:VENDETTA CHIROPRACTIC CORP.
Entity Type:Organization
Organization Name:VENDETTA CHIROPRACTIC CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:VENDETTA
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:949-548-5800
Mailing Address - Street 1:P.O. BOX 4298
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92628-4298
Mailing Address - Country:US
Mailing Address - Phone:949-548-5800
Mailing Address - Fax:949-548-5803
Practice Address - Street 1:1905 FULLERTON AVE, #A
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2277
Practice Address - Country:US
Practice Address - Phone:949-548-5800
Practice Address - Fax:949-548-5803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22881111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty