Provider Demographics
NPI:1982633863
Name:HD PHYSICAL MEDICINE A PROFESSIONAL MEDICAL CORP
Entity Type:Organization
Organization Name:HD PHYSICAL MEDICINE A PROFESSIONAL MEDICAL CORP
Other - Org Name:DBA: STINE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:STINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-245-8182
Mailing Address - Street 1:17330 BEAR VALLEY RD
Mailing Address - Street 2:STE 105
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395
Mailing Address - Country:US
Mailing Address - Phone:760-245-8182
Mailing Address - Fax:760-245-2123
Practice Address - Street 1:17330 BEAR VALLEY RD
Practice Address - Street 2:STE 105
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395
Practice Address - Country:US
Practice Address - Phone:760-245-8182
Practice Address - Fax:760-245-2123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U44701Medicare UPIN
CADC0215230Medicare ID - Type Unspecified