Provider Demographics
NPI:1144303934
Name:JAUREGUI WRIGHTWOOD CHIROPRACTIC CARE, INC
Entity type:Organization
Organization Name:JAUREGUI WRIGHTWOOD CHIROPRACTIC CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAUREGUI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-249-6877
Mailing Address - Street 1:15550 ROCKFIELD BLVD
Mailing Address - Street 2:B220
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2720
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:1261 EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:WRIGHTWOOD
Practice Address - State:CA
Practice Address - Zip Code:92397
Practice Address - Country:US
Practice Address - Phone:760-249-6877
Practice Address - Fax:760-249-6377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0282460OtherBLUE SHIELD
CADC28246OtherCHIROPRACTIC LICENSE
CADC28246OtherCHIROPRACTIC LICENSE
CAV07169Medicare UPIN