Healthcare Provider Details

I. General information

NPI: 1275441578
Provider Name (Legal Business Name): URSICH CHIROPRACTIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29000 S WESTERN AVE STE 102
RANCHO PALOS VERDES CA
90275-0818
US

IV. Provider business mailing address

29000 S WESTERN AVE STE 102
RANCHO PALOS VERDES CA
90275-0818
US

V. Phone/Fax

Practice location:
  • Phone: 310-598-2798
  • Fax:
Mailing address:
  • Phone: 310-598-2798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY J URSICH
Title or Position: PRESIDENT
Credential: DC
Phone: 310-598-2798