Healthcare Provider Details

I. General information

NPI: 1760652051
Provider Name (Legal Business Name): GRECIAN CHIROPRACTIC AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 NEWPORT BLVD SUIT 185
COSTA MESA CA
92627-2278
US

IV. Provider business mailing address

1901 NEWPORT BLVD SUIT 185
COSTA MESA CA
92627-2278
US

V. Phone/Fax

Practice location:
  • Phone: 949-548-3818
  • Fax: 949-548-3821
Mailing address:
  • Phone: 949-548-3818
  • Fax: 949-548-3821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number27603
License Number StateCA

VIII. Authorized Official

Name: DR. TODD PIERSON GRECIAN
Title or Position: CEO/ PHYSICIAN
Credential: D.C.
Phone: 949-548-3818