Provider Demographics
NPI:1144520040
Name:MINES, JULIAN LANSING IV (DC)
Entity type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:LANSING
Last Name:MINES
Suffix:IV
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:4 CALLE CELESTIAL
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6914
Mailing Address - Country:US
Mailing Address - Phone:949-436-2601
Mailing Address - Fax:
Practice Address - Street 1:214 AVENIDA DEL MAR
Practice Address - Street 2:SUITE A
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-5540
Practice Address - Country:US
Practice Address - Phone:949-436-2601
Practice Address - Fax:949-498-4718
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CADC24513111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation