Provider Demographics
NPI:1669797833
Name:NEUROLOGICAL HEALING, INC.
Entity type:Organization
Organization Name:NEUROLOGICAL HEALING, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIRK
Authorized Official - Middle Name:HANS
Authorized Official - Last Name:KANCILIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-630-9153
Mailing Address - Street 1:2835 CAMINO DEL RIO S STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3825
Mailing Address - Country:US
Mailing Address - Phone:619-630-9153
Mailing Address - Fax:619-550-4671
Practice Address - Street 1:2835 CAMINO DEL RIO S STE 110
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3825
Practice Address - Country:US
Practice Address - Phone:619-630-9153
Practice Address - Fax:619-550-4671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27281111N00000X
CADC016440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty