Healthcare Provider Details

I. General information

NPI: 1043534431
Provider Name (Legal Business Name): LA PAZ CHIROPRACTIC AND REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25200 LA PAZ RD SUITE 102
LAGUNA HILLS CA
92653-5110
US

IV. Provider business mailing address

25200 LA PAZ RD SUITE 102
LAGUNA HILLS CA
92653-5110
US

V. Phone/Fax

Practice location:
  • Phone: 949-770-8767
  • Fax: 949-770-0836
Mailing address:
  • Phone: 949-770-8767
  • Fax: 949-770-0836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number29776
License Number StateCA

VIII. Authorized Official

Name: MR. CHARLES P ADAMO
Title or Position: OWNER
Credential: D.C.
Phone: 949-770-8767