Provider Demographics
NPI:1013278068
Name:PREMIER CHIROPRACTIC, A RUNDLE CORPORATION
Entity Type:Organization
Organization Name:PREMIER CHIROPRACTIC, A RUNDLE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:RUNDLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-588-7011
Mailing Address - Street 1:25401 CABOT RD STE 112
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5513
Mailing Address - Country:US
Mailing Address - Phone:949-588-7011
Mailing Address - Fax:949-588-7012
Practice Address - Street 1:25401 CABOT RD STE 112
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5513
Practice Address - Country:US
Practice Address - Phone:949-588-7011
Practice Address - Fax:949-588-7012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHD912AMedicare PIN