Provider Demographics
NPI:1205097771
Name:SOLIS CHIROPRACTIC INC
Entity type:Organization
Organization Name:SOLIS CHIROPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-297-1519
Mailing Address - Street 1:1851 SAN DIEGO AVE
Mailing Address - Street 2:100B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2176
Mailing Address - Country:US
Mailing Address - Phone:619-297-1519
Mailing Address - Fax:619-297-0705
Practice Address - Street 1:1851 SAN DIEGO AVE
Practice Address - Street 2:100B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-2176
Practice Address - Country:US
Practice Address - Phone:619-297-1519
Practice Address - Fax:619-297-0705
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOLIS CHIROPRACTIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA21516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA21516OtherMEDICARE