Healthcare Provider Details

I. General information

NPI: 1831562487
Provider Name (Legal Business Name): CORE INTEGRATED HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10801 FOOTHILL BLVD SUITE 104
RANCHO CUCAMONGA CA
91730-7694
US

IV. Provider business mailing address

10801 FOOTHILL BLVD SUITE 104
RANCHO CUCAMONGA CA
91730-7694
US

V. Phone/Fax

Practice location:
  • Phone: 909-989-4435
  • Fax: 909-989-4461
Mailing address:
  • Phone: 909-989-4435
  • Fax: 909-989-4461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number23557
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 11452
License Number StateCA

VIII. Authorized Official

Name: DR. CORAZON C LANYON
Title or Position: OWNER, CLINIC DIRECTOR
Credential: DC
Phone: 909-989-4435