Healthcare Provider Details

I. General information

NPI: 1992979538
Provider Name (Legal Business Name): MY CENTER FOR CHIROPRACTIC & ANTI-AGING MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26990 CROWN VALLEY PKWY SUITE C
MISSION VIEJO CA
92691-6548
US

IV. Provider business mailing address

26990 CROWN VALLEY PKWY SUITE C
MISSION VIEJO CA
92691-6548
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-5656
  • Fax:
Mailing address:
  • Phone: 949-364-5656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC14686
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA60570
License Number StateCA

VIII. Authorized Official

Name: DAVID C MANAGO
Title or Position: PRESIDENT
Credential: DC
Phone: 949-364-5656