Healthcare Provider Details

I. General information

NPI: 1518309962
Provider Name (Legal Business Name): ORTHOPEDIC LASER INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 2ND ST
ENCINITAS CA
92024-4408
US

IV. Provider business mailing address

848 2ND ST
ENCINITAS CA
92024-4408
US

V. Phone/Fax

Practice location:
  • Phone: 760-436-4325
  • Fax:
Mailing address:
  • Phone: 760-436-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHELLE BINKOWSKI
Title or Position: PRESIDENT
Credential: DC
Phone: 760-436-4325