Healthcare Provider Details

I. General information

NPI: 1932315025
Provider Name (Legal Business Name): MIRA MESA CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 OBERLIN DR STE 100
SAN DIEGO CA
92121-4710
US

IV. Provider business mailing address

PO BOX 1176
CARDIFF CA
92007-7176
US

V. Phone/Fax

Practice location:
  • Phone: 760-436-7999
  • Fax: 760-436-3993
Mailing address:
  • Phone: 760-436-7999
  • Fax: 760-436-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC12047
License Number StateCA

VIII. Authorized Official

Name: DR. GALE THELMA SAVAGE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 760-436-7999