Provider Demographics
NPI:1134771058
Name:AHAVA CHIROPRACTIC A ROSAS CORPORATION
Entity type:Organization
Organization Name:AHAVA CHIROPRACTIC A ROSAS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-454-6227
Mailing Address - Street 1:4475 SOTO ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-3404
Mailing Address - Country:US
Mailing Address - Phone:714-454-6227
Mailing Address - Fax:
Practice Address - Street 1:481 N CENTRAL AVE STE B
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-7283
Practice Address - Country:US
Practice Address - Phone:714-454-6227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty