Healthcare Provider Details

I. General information

NPI: 1750893509
Provider Name (Legal Business Name): DZENDZEL FAMILY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2017
Last Update Date: 11/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 CLAIREMONT DRIVE STE 2
SAN DIEGO CA
92117
US

IV. Provider business mailing address

3650 CLAIREMONT DRIVE STE 2
SAN DIEGO CA
92117
US

V. Phone/Fax

Practice location:
  • Phone: 858-272-7002
  • Fax:
Mailing address:
  • Phone: 858-272-7002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC26381
License Number StateCA

VIII. Authorized Official

Name: DR. JOSEPH DAVID DZENDZEL
Title or Position: PRESIDENT
Credential: D.C.
Phone: 858-272-7002