Healthcare Provider Details

I. General information

NPI: 1881014157
Provider Name (Legal Business Name): FALLBROOK SPINE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

746 S MAIN AVE SUITE D
FALLBROOK CA
92028-3333
US

IV. Provider business mailing address

746 S MAIN AVE SUITE D
FALLBROOK CA
92028-3333
US

V. Phone/Fax

Practice location:
  • Phone: 760-728-8999
  • Fax: 760-728-0821
Mailing address:
  • Phone: 760-728-8999
  • Fax: 760-728-0821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberDC12036
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5352
License Number StateCA

VIII. Authorized Official

Name: DR. DEAN ROBINSON
Title or Position: OWNER
Credential: DC
Phone: 760-728-8999