Provider Demographics
NPI:1942486220
Name:LARRY BASCH CHIROPRACTIC INC
Entity Type:Organization
Organization Name:LARRY BASCH CHIROPRACTIC INC
Other - Org Name:MENIFEE VALLEY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BASCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-679-4121
Mailing Address - Street 1:26820 CHERRY HILLS BLVD
Mailing Address - Street 2:STE. 4
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-2531
Mailing Address - Country:US
Mailing Address - Phone:951-679-4121
Mailing Address - Fax:951-679-2306
Practice Address - Street 1:26820 CHERRY HILLS BLVD
Practice Address - Street 2:STE. 4
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-2531
Practice Address - Country:US
Practice Address - Phone:951-679-4121
Practice Address - Fax:951-679-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23495111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0234950Medicare PIN