Healthcare Provider Details

I. General information

NPI: 1992091987
Provider Name (Legal Business Name): ALES CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19240 BEACH BLVD
HUNTINGTON BEACH CA
92648-2310
US

IV. Provider business mailing address

15550 ROCKFIELD BLVD B220
IRVINE CA
92618-2720
US

V. Phone/Fax

Practice location:
  • Phone: 818-766-1128
  • Fax:
Mailing address:
  • Phone: 949-598-9999
  • Fax: 949-598-9990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC30278
License Number StateCA

VIII. Authorized Official

Name: BRYAN L ALES
Title or Position: CLINIC OWNER
Credential: D.C.
Phone: 818-766-1128