Healthcare Provider Details

I. General information

NPI: 1285717645
Provider Name (Legal Business Name): SAM C HO, A PROFESSIONAL CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39755 DATE STREET #207
MURRIETA CA
92563-2008
US

IV. Provider business mailing address

39755 DATE STREET #207
MURRIETA CA
92563-2008
US

V. Phone/Fax

Practice location:
  • Phone: 951-698-7977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC28958
License Number StateCA

VIII. Authorized Official

Name: DR. SAM CHIN HO
Title or Position: CEO
Credential: D.C.
Phone: 951-264-4811