Healthcare Provider Details

I. General information

NPI: 1629645643
Provider Name (Legal Business Name): AMP SPORTS MED INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 INDUSTRIAL PARK AVE
REDLANDS CA
92374-2897
US

IV. Provider business mailing address

1380 INDUSTRIAL PARK AVE
REDLANDS CA
92374-2897
US

V. Phone/Fax

Practice location:
  • Phone: 949-264-6440
  • Fax:
Mailing address:
  • Phone: 949-264-6440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JACINTO M FLORES-ALVAREZ
Title or Position: OWNER
Credential: DC
Phone: 949-264-6440