Provider Demographics
NPI:1750674552
Name:CHERRY CHIROPRACTIC
Entity type:Organization
Organization Name:CHERRY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-945-8200
Mailing Address - Street 1:510 HACIENDA DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-6637
Mailing Address - Country:US
Mailing Address - Phone:760-630-8060
Mailing Address - Fax:760-630-7715
Practice Address - Street 1:510 HACIENDA DR
Practice Address - Street 2:SUITE 107
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6637
Practice Address - Country:US
Practice Address - Phone:760-630-8060
Practice Address - Fax:760-630-7715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty