Healthcare Provider Details

I. General information

NPI: 1366350456
Provider Name (Legal Business Name): DYNAMIC FORM CHIROPRACTIC, D. ROSSI INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 E KATELLA AVE STE 211
ORANGE CA
92867-5050
US

IV. Provider business mailing address

1224 E KATELLA AVE STE 211
ORANGE CA
92867-5050
US

V. Phone/Fax

Practice location:
  • Phone: 310-597-3578
  • Fax:
Mailing address:
  • Phone: 310-597-3578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL ROSSI
Title or Position: PRESIDENT
Credential: DC
Phone: 310-597-3578