Healthcare Provider Details

I. General information

NPI: 1285714998
Provider Name (Legal Business Name): WADE MATTSON BINLEY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 MONARCH BAY PLAZA SUITE L
DANA POINT CA
92629
US

IV. Provider business mailing address

28 MONARCH BAY PLAZA SUITE L
DANA POINT CA
92629
US

V. Phone/Fax

Practice location:
  • Phone: 949-661-9777
  • Fax: 949-661-3747
Mailing address:
  • Phone: 949-661-9777
  • Fax: 949-661-3747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number16266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: