Healthcare Provider Details

I. General information

NPI: 1639256340
Provider Name (Legal Business Name): KENT ALAN SVENINGSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MONARCH BAY PLZ SUITE 109
DANA POINT CA
92629-3440
US

IV. Provider business mailing address

3 MONARCH BAY PLZ SUITE 109
DANA POINT CA
92629-3440
US

V. Phone/Fax

Practice location:
  • Phone: 949-218-7671
  • Fax: 949-371-8056
Mailing address:
  • Phone: 949-218-7671
  • Fax: 949-371-8056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number21528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: