Healthcare Provider Details

I. General information

NPI: 1275880221
Provider Name (Legal Business Name): PUBLICO CHIROPRACTIC IN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2958 MADISON ST #101
CARLSBAD CA
92008-2359
US

IV. Provider business mailing address

2958 MADISON ST #101
CARLSBAD CA
92008-2359
US

V. Phone/Fax

Practice location:
  • Phone: 760-434-1756
  • Fax: 760-434-2482
Mailing address:
  • Phone: 760-434-1756
  • Fax: 760-434-2482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 30631
License Number StateCA

VIII. Authorized Official

Name: PATRICIA JEAN MASTERS-PUBLICO
Title or Position: OFFICER: VICE PRESIDENT
Credential:
Phone: 760-434-1756