Provider Demographics
NPI:1770076796
Name:DR. PORTER SPORTS CHIROPRACTIC & WELLNESS INC.
Entity type:Organization
Organization Name:DR. PORTER SPORTS CHIROPRACTIC & WELLNESS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-582-0770
Mailing Address - Street 1:2345 ERRINGER RD STE 210
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2250
Mailing Address - Country:US
Mailing Address - Phone:805-582-0770
Mailing Address - Fax:805-582-0003
Practice Address - Street 1:2345 ERRINGER RD STE 210
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2250
Practice Address - Country:US
Practice Address - Phone:805-582-0770
Practice Address - Fax:805-582-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31635261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care