Provider Demographics
NPI:1184953721
Name:MIRANDA CHIROPRACTIC SPECIALTY GROUP INC.
Entity type:Organization
Organization Name:MIRANDA CHIROPRACTIC SPECIALTY GROUP INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMUND
Authorized Official - Middle Name:GALLANOSA
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-846-5866
Mailing Address - Street 1:9855 ERMA RD
Mailing Address - Street 2:SUITE 129
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3001
Mailing Address - Country:US
Mailing Address - Phone:858-549-1541
Mailing Address - Fax:858-549-1572
Practice Address - Street 1:9855 ERMA RD
Practice Address - Street 2:SUITE 129
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-3001
Practice Address - Country:US
Practice Address - Phone:858-549-1541
Practice Address - Fax:858-549-1572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25256111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty