Provider Demographics
NPI:1548313117
Name:DEL CID, BORIS ENRIQUE (DC)
Entity type:Individual
Prefix:DR
First Name:BORIS
Middle Name:ENRIQUE
Last Name:DEL CID
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 1:707 CALLE MONSERRAT
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-2371
Mailing Address - Country:US
Mailing Address - Phone:949-357-7477
Mailing Address - Fax:949-361-4311
Practice Address - Street 1:33159 CAMINO CAPISTRANO
Practice Address - Street 2:SUITE D
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-4827
Practice Address - Country:US
Practice Address - Phone:949-488-0016
Practice Address - Fax:949-488-0507
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20952111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU18380Medicare UPIN
CAWDC7932Medicare ID - Type UnspecifiedID