Provider Demographics
NPI:1730339540
Name:ORTIZ CHIROPRACTIC A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ORTIZ CHIROPRACTIC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIC
Authorized Official - Middle Name:CARLO
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-808-9091
Mailing Address - Street 1:3833 BEDFORD CANYON RD
Mailing Address - Street 2:SUITE C102
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-0788
Mailing Address - Country:US
Mailing Address - Phone:951-808-9091
Mailing Address - Fax:951-808-9702
Practice Address - Street 1:3833 BEDFORD CANYON RD
Practice Address - Street 2:SUITE C102
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-0788
Practice Address - Country:US
Practice Address - Phone:951-808-9091
Practice Address - Fax:951-808-9702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26464111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0264640Medicare UPIN