Healthcare Provider Details

I. General information

NPI: 1639258239
Provider Name (Legal Business Name): GELLER MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 K ST UNIT B PMB#371
SAN DIEGO CA
92101-7091
US

IV. Provider business mailing address

465 COLLEGE BLVD STE 1
OCEANSIDE CA
92057-5435
US

V. Phone/Fax

Practice location:
  • Phone: 760-207-2768
  • Fax: 760-557-2309
Mailing address:
  • Phone: 760-630-8400
  • Fax: 760-630-8594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC19135
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC25424
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT26629
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT2851
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17862
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20A8052
License Number StateCA

VIII. Authorized Official

Name: DR. RANDALL CRAIG GREGSON
Title or Position: CLINIC DIRECTOR
Credential: D.C.
Phone: 760-630-8400