Healthcare Provider Details

I. General information

NPI: 1427742147
Provider Name (Legal Business Name): ALYSSA CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18600 MAIN ST STE 110
HUNTINGTON BEACH CA
92648-1715
US

IV. Provider business mailing address

835 PEBBLE BEACH DR
UPLAND CA
91784-9133
US

V. Phone/Fax

Practice location:
  • Phone: 714-794-2171
  • Fax:
Mailing address:
  • Phone: 909-922-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. ALYSSA GRANADOS
Title or Position: CHIROPRACTOR/ PRESIDENT
Credential: DC
Phone: 909-922-4440