Healthcare Provider Details

I. General information

NPI: 1245753458
Provider Name (Legal Business Name): HARNITCHEK CHIROPRACTIC PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 S D ST STE 108
SAN BERNARDINO CA
92408-3232
US

IV. Provider business mailing address

1535 S D ST STE 108
SAN BERNARDINO CA
92408-3232
US

V. Phone/Fax

Practice location:
  • Phone: 909-783-9400
  • Fax:
Mailing address:
  • Phone: 909-783-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAM YEM
Title or Position: MANAGER
Credential:
Phone: 909-784-9400