Provider Demographics
NPI:1982813838
Name:RANCHO LAS PALMAS CHIROPRACTIC
Entity Type:Organization
Organization Name:RANCHO LAS PALMAS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:I
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-346-0082
Mailing Address - Street 1:42700 BOB HOPE DR STE 306
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-7162
Mailing Address - Country:US
Mailing Address - Phone:760-346-0082
Mailing Address - Fax:760-341-3071
Practice Address - Street 1:42700 BOB HOPE DR STE 306
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-7162
Practice Address - Country:US
Practice Address - Phone:760-346-0082
Practice Address - Fax:760-341-3071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17769111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty