Provider Demographics
NPI:1144550450
Name:SURACES CHIROPRACTIC BACK ALERT CLINIC, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SURACES CHIROPRACTIC BACK ALERT CLINIC, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:SURACE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-831-5700
Mailing Address - Street 1:643 S BUTTE ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3510
Mailing Address - Country:US
Mailing Address - Phone:310-831-5700
Mailing Address - Fax:310-831-5700
Practice Address - Street 1:643 S BUTTE ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3510
Practice Address - Country:US
Practice Address - Phone:310-831-5700
Practice Address - Fax:310-831-5700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10283302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization