Healthcare Provider Details

I. General information

NPI: 1558286658
Provider Name (Legal Business Name): ULTA CARE GANSERT CHIROPRACTIC PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 MACKAY DR STE APT
SAN BERNARDINO CA
92408-3230
US

IV. Provider business mailing address

423 MACKAY DR STE APT
SAN BERNARDINO CA
92408-3230
US

V. Phone/Fax

Practice location:
  • Phone: 626-665-8135
  • Fax: 909-460-0433
Mailing address:
  • Phone: 626-665-8135
  • Fax: 909-460-0433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. KEVIN KARL GANSERT
Title or Position: CEO
Credential: GANSERT
Phone: 626-852-2268