Healthcare Provider Details

I. General information

NPI: 1093941387
Provider Name (Legal Business Name): PCH CHIRO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6557 E. PCH H-10
LONG BEACH CA
90803-4202
US

IV. Provider business mailing address

6557 E. PCH H-10
LONG BEACH CA
90803-4202
US

V. Phone/Fax

Practice location:
  • Phone: 562-430-8501
  • Fax: 562-430-8591
Mailing address:
  • Phone: 562-430-8501
  • Fax: 562-430-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC24587
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number24587
License Number StateCA

VIII. Authorized Official

Name: MR. ADAM L SANDAHL
Title or Position: OWN/DOCTOR
Credential: DC
Phone: 562-430-8501