Healthcare Provider Details

I. General information

NPI: 1649320540
Provider Name (Legal Business Name): LA PAZ CHIROPRACTIC AND REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 01/10/2012
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 TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number29776
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES PHILIP ADAMO
Title or Position: DR.OF CHIPROCTIC
Credential: D.C.
Phone: 949-770-8767