Healthcare Provider Details

I. General information

NPI: 1750847562
Provider Name (Legal Business Name): SPECTRUM CHIROPRACTIC AN OCHOA-REA CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2019
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3069 LINCOLN AVE
SAN DIEGO CA
92104-3030
US

IV. Provider business mailing address

3069 LINCOLN AVE
SAN DIEGO CA
92104-3030
US

V. Phone/Fax

Practice location:
  • Phone: 619-300-3838
  • Fax:
Mailing address:
  • Phone: 619-300-3838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANGEL GERARDO OCHOA-REA
Title or Position: CEO
Credential: DC
Phone: 619-300-3838