Provider Demographics
NPI:1134362460
Name:SOUTHLAND CHIROPRACTIC
Entity type:Organization
Organization Name:SOUTHLAND CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MERICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:ABRAJANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-534-4838
Mailing Address - Street 1:15550 ROCKFIELD BLVD
Mailing Address - Street 2:B220
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2720
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:2424 WEST SEPULVEDA BOULEVARD
Practice Address - Street 2:STE O
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-4335
Practice Address - Country:US
Practice Address - Phone:310-534-4838
Practice Address - Fax:310-784-8563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23489111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23489OtherCHIROPRACTIC LICENSE
CADC0234890OtherBLUE SHIELD
CADC23489OtherCHIROPRACTIC LICENSE