Provider Demographics
NPI:1831562487
Name:CORE INTEGRATED HEALTH
Entity type:Organization
Organization Name:CORE INTEGRATED HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CORAZON
Authorized Official - Middle Name:C
Authorized Official - Last Name:LANYON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:909-989-4435
Mailing Address - Street 1:10801 FOOTHILL BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7694
Mailing Address - Country:US
Mailing Address - Phone:909-989-4435
Mailing Address - Fax:909-989-4461
Practice Address - Street 1:10801 FOOTHILL BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7694
Practice Address - Country:US
Practice Address - Phone:909-989-4435
Practice Address - Fax:909-989-4461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 11452171100000X
CA23557111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty