Healthcare Provider Details

I. General information

NPI: 1457666182
Provider Name (Legal Business Name): CHIROREHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 OLD NEWPORT BLVD SUITE D
NEWPORT BEACH CA
92663-4250
US

IV. Provider business mailing address

425 OLD NEWPORT BLVD SUITE D
NEWPORT BEACH CA
92663-4250
US

V. Phone/Fax

Practice location:
  • Phone: 949-631-6432
  • Fax: 949-258-5858
Mailing address:
  • Phone: 949-631-6432
  • Fax: 949-258-5858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number31139
License Number StateCA

VIII. Authorized Official

Name: DR. DAMIEN JOHANN BURGESS
Title or Position: CHIROPRACTOR/OWNER
Credential: DC
Phone: 949-631-6432