Provider Demographics
NPI:1134211535
Name:MANSOUR, ALBERT D (DC)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:D
Last Name:MANSOUR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2983 CHINO AVE
Mailing Address - Street 2:SUITE A-6
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3576
Mailing Address - Country:US
Mailing Address - Phone:909-465-5454
Mailing Address - Fax:
Practice Address - Street 1:14740 PIPELINE AVE STE A
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1293
Practice Address - Country:US
Practice Address - Phone:909-393-4545
Practice Address - Fax:909-393-3899
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20299111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC02290Medicare ID - Type UnspecifiedMEDICARE I.D. #