Provider Demographics
NPI:1275677767
Name:ALIS, SUPNA CHHABRA (DC)
Entity Type:Individual
Prefix:
First Name:SUPNA
Middle Name:CHHABRA
Last Name:ALIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30320 RANCHO VIEJO RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1582
Mailing Address - Country:US
Mailing Address - Phone:949-218-4520
Mailing Address - Fax:
Practice Address - Street 1:30320 RANCHO VIEJO RD STE 103
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1582
Practice Address - Country:US
Practice Address - Phone:949-218-4520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26542111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition