Healthcare Provider Details

I. General information

NPI: 1275071920
Provider Name (Legal Business Name): VAHL CHIROPRACTIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

171 SAXONY RD STE 107
ENCINITAS CA
92024-6776
US

IV. Provider business mailing address

2767 WORDEN ST
SAN DIEGO CA
92110
US

V. Phone/Fax

Practice location:
  • Phone: 760-479-0146
  • Fax:
Mailing address:
  • Phone: 619-647-4732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number30438
License Number StateCA

VIII. Authorized Official

Name: MR. JAMES BRIAN VAHL
Title or Position: PRESIDENT
Credential: DC
Phone: 760-479-0146