Provider Demographics
NPI:1992188320
Name:PACIFIC CHIROPRACTIC & WELLNESS CENTER
Entity Type:Organization
Organization Name:PACIFIC CHIROPRACTIC & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:FERESHTEH
Authorized Official - Middle Name:
Authorized Official - Last Name:SAEEDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-505-1901
Mailing Address - Street 1:180 E MAIN ST STE 106
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-4459
Mailing Address - Country:US
Mailing Address - Phone:714-505-1901
Mailing Address - Fax:714-884-3391
Practice Address - Street 1:180 E MAIN ST STE 106
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-4459
Practice Address - Country:US
Practice Address - Phone:714-505-1901
Practice Address - Fax:714-884-3391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33325111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty