Provider Demographics
NPI:1245095744
Name:CASILLAS CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:CASILLAS CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CASILLAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-696-0085
Mailing Address - Street 1:6317 MONTEREY RD APT 309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-4382
Mailing Address - Country:US
Mailing Address - Phone:209-696-0085
Mailing Address - Fax:
Practice Address - Street 1:17522 COLIMA RD
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-1750
Practice Address - Country:US
Practice Address - Phone:626-935-9733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty