Healthcare Provider Details

I. General information

NPI: 1225189905
Provider Name (Legal Business Name): CANDELARIO CHIROPRACTIC A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 BONITA RD SUITE B
BONITA CA
91902-1701
US

IV. Provider business mailing address

5030 BONITA RD SUITE B
BONITA CA
91902-1701
US

V. Phone/Fax

Practice location:
  • Phone: 619-479-7473
  • Fax: 619-479-9376
Mailing address:
  • Phone: 619-479-7473
  • Fax: 619-479-9376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 28449
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 8793
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE RODEL CANDELARIO
Title or Position: PRESIDENT
Credential: D.C
Phone: 619-479-7473