Healthcare Provider Details

I. General information

NPI: 1720051238
Provider Name (Legal Business Name): PUBLICO CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2958 MADISON ST. SUITE #101
CARLSBAD CA
92008
US

IV. Provider business mailing address

2958 MADISON ST. SUITE #101
CARLSBAD CA
92008
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 TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number13855
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC17868
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC29643
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC30631
License Number StateCA

VIII. Authorized Official

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