Provider Demographics
NPI:1184634107
Name:CENTER FOR ORTHOPEDICS & REHABILITATION MEDICAL GROUP
Entity type:Organization
Organization Name:CENTER FOR ORTHOPEDICS & REHABILITATION MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIGI
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRCHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:661-274-8725
Mailing Address - Street 1:1405 W RANCHO VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3968
Mailing Address - Country:US
Mailing Address - Phone:661-274-8725
Mailing Address - Fax:661-274-8025
Practice Address - Street 1:1405 W RANCHO VISTA BLVD
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3968
Practice Address - Country:US
Practice Address - Phone:661-274-8725
Practice Address - Fax:661-274-8025
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLIED CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-09
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA207RS0012XOtherINTERNAL MEDICINE - SLEEP MEDICINE