Healthcare Provider Details

I. General information

NPI: 1649571365
Provider Name (Legal Business Name): ROBINSON R. LANGILLE CHIROPRACTIC CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 UNIVERSITY AVE SUITE C-201
SAN DIEGO CA
92103-3398
US

IV. Provider business mailing address

4155 EXECUTIVE DR SUITE E401
LA JOLLA CA
92037-1351
US

V. Phone/Fax

Practice location:
  • Phone: 619-992-5933
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number30232
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number30232
License Number StateCA

VIII. Authorized Official

Name: ROBINSON REED LANGILLE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 415-971-4816