Healthcare Provider Details

I. General information

NPI: 1861859803
Provider Name (Legal Business Name): SPORTSLAB SOCAL DR. JC ZEGARRA CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 ICON
FOOTHILL RANCH CA
92610-3000
US

IV. Provider business mailing address

74 ICON
FOOTHILL RANCH CA
92610-3000
US

V. Phone/Fax

Practice location:
  • Phone: 949-390-9209
  • Fax: 949-271-4671
Mailing address:
  • Phone: 949-390-9209
  • Fax: 949-271-4671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number32913
License Number StateCA

VIII. Authorized Official

Name: DR. JAN CARLO ZEGARRA
Title or Position: PRESIDENT
Credential: D.C.
Phone: 787-234-8371