Provider Demographics
NPI:1649436486
Name:LLANTADA CHIROPRACTIC A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:LLANTADA CHIROPRACTIC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUMEL
Authorized Official - Middle Name:MENDOZA
Authorized Official - Last Name:LLANTADA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:858-384-6556
Mailing Address - Street 1:5252 BALBOA AVE STE 701
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6930
Mailing Address - Country:US
Mailing Address - Phone:858-384-6556
Mailing Address - Fax:858-225-8320
Practice Address - Street 1:5252 BALBOA AVE STE 701
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6930
Practice Address - Country:US
Practice Address - Phone:858-384-6556
Practice Address - Fax:858-225-8320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACOR2360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty