Healthcare Provider Details

I. General information

NPI: 1699970574
Provider Name (Legal Business Name): COCKS AND SHAKIB CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 01/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15435 JEFFREY RD SUITE 138
IRVINE CA
92618-4104
US

IV. Provider business mailing address

15435 JEFFREY RD SUITE 138
IRVINE CA
92618-4104
US

V. Phone/Fax

Practice location:
  • Phone: 949-552-5535
  • Fax: 949-552-3022
Mailing address:
  • Phone: 949-552-5535
  • Fax: 949-552-3022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2407
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT20837
License Number StateCA

VIII. Authorized Official

Name: DR. STEVEN MICHAEL COCKS
Title or Position: CFO
Credential: D.C.
Phone: 949-552-5535