Provider Demographics
NPI:1770778938
Name:RAMONA CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:RAMONA CHIROPRACTIC CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:AGLIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-789-2520
Mailing Address - Street 1:1721 MAIN ST STE 107
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-2239
Mailing Address - Country:US
Mailing Address - Phone:760-789-2520
Mailing Address - Fax:760-789-2528
Practice Address - Street 1:1721 MAIN ST STE 107
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-2239
Practice Address - Country:US
Practice Address - Phone:760-789-2520
Practice Address - Fax:760-789-2528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC18268AMedicare UPIN
CAW19648Medicare UPIN