Provider Demographics
NPI:1205925542
Name:BOTELHO, EMANUEL H (DC)
Entity type:Individual
Prefix:DR
First Name:EMANUEL
Middle Name:H
Last Name:BOTELHO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 S MORNINGSTAR DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1632
Mailing Address - Country:US
Mailing Address - Phone:951-587-0100
Mailing Address - Fax:951-587-0101
Practice Address - Street 1:27699 JEFFERSON AVE STE 203
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2696
Practice Address - Country:US
Practice Address - Phone:951-587-0100
Practice Address - Fax:951-587-0101
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31969111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1613812Medicaid
MAY45305Medicare ID - Type Unspecified