Healthcare Provider Details

I. General information

NPI: 1902392624
Provider Name (Legal Business Name): LIFE ADJUSTED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 LEBON DR #525
SAN DIEGO CA
92122
US

IV. Provider business mailing address

3425 LEBON DR #525
SAN DIEGO CA
92122
US

V. Phone/Fax

Practice location:
  • Phone: 530-643-7723
  • Fax:
Mailing address:
  • Phone: 530-643-7723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. ANGELICA M. ORTIZ
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 562-321-8213