Healthcare Provider Details

I. General information

NPI: 1609315944
Provider Name (Legal Business Name): REFORM CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10345 LAKEWOOD BLVD
DOWNEY CA
90241-2743
US

IV. Provider business mailing address

3208 BUDLEIGH DR
HACIENDA HEIGHTS CA
91745-6405
US

V. Phone/Fax

Practice location:
  • Phone: 562-287-8884
  • Fax:
Mailing address:
  • Phone: 626-374-2302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number33626
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number33626
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number33626
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number33626
License Number StateCA

VIII. Authorized Official

Name: DR. DANIEL SANCHEZ
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 626-374-2302