Healthcare Provider Details
I. General information
NPI: 1730463563
Provider Name (Legal Business Name): R. CHEN CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 09/28/2011
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
20905 GOLDEN SPRINGS DR
DIAMOND BAR CA
91789-3806
US
IV. Provider business mailing address
20905 GOLDEN SPRINGS DR
DIAMOND BAR CA
91789-3806
US
V. Phone/Fax
- Phone: 909-468-2192
- Fax:
- Phone: 909-468-2192
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225200000X |
| Taxonomy | Physical Therapy Assistant |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225700000X |
| Taxonomy | Massage Therapist |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 111NR0400X |
| Taxonomy | Rehabilitation Chiropractor |
| License Number | DC30668 |
| License Number State | CA |
| # 4 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 225100000X |
| Taxonomy | Physical Therapist |
| License Number | PT29435 |
| License Number State | CA |
VIII. Authorized Official
Name: DR.
ROBBY
M
CHEN
Title or Position: OWNER
Credential: D.C.
Phone: 909-468-2192