Provider Demographics
NPI:1649681800
Name:THERESA BAXTER L.AC.
Entity type:Organization
Organization Name:THERESA BAXTER L.AC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-306-4492
Mailing Address - Street 1:2425 CAMINO DEL RIO S
Mailing Address - Street 2:STE 180
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3744
Mailing Address - Country:US
Mailing Address - Phone:619-294-2225
Mailing Address - Fax:
Practice Address - Street 1:2425 CAMINO DEL RIO S
Practice Address - Street 2:STE 180
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3744
Practice Address - Country:US
Practice Address - Phone:619-294-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORES CHIROPRACTIC INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9679261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty