Provider Demographics
NPI:1265762124
Name:BACHOUA, DANNY BASIL (DC)
Entity type:Individual
Prefix:DR
First Name:DANNY
Middle Name:BASIL
Last Name:BACHOUA
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 1:3691 VIA MERCADO
Mailing Address - Street 2:UNIT 15
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-8301
Mailing Address - Country:US
Mailing Address - Phone:619-444-3191
Mailing Address - Fax:619-444-3193
Practice Address - Street 1:3691 VIA MERCADO
Practice Address - Street 2:UNIT 15
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-8301
Practice Address - Country:US
Practice Address - Phone:619-444-3191
Practice Address - Fax:619-444-3193
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-28
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31479111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation