Healthcare Provider Details

I. General information

NPI: 1083110274
Provider Name (Legal Business Name): JC CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 BROADWAY STE 2
CHULA VISTA CA
91910-3502
US

IV. Provider business mailing address

320 BROADWAY STE 2
CHULA VISTA CA
91910-3502
US

V. Phone/Fax

Practice location:
  • Phone: 619-422-0404
  • Fax:
Mailing address:
  • Phone: 619-422-0404
  • Fax: 619-422-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC28449
License Number StateCA

VIII. Authorized Official

Name: DR. JOSE CANDELARIO
Title or Position: PRESIDENT
Credential: D.C.
Phone: 619-422-0404