Healthcare Provider Details

I. General information

NPI: 1760778062
Provider Name (Legal Business Name): PLUTCHOK CHIROPRACTIC & WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 EXECUTIVE DR PLAZA 5
SAN DIEGO CA
92121-3021
US

IV. Provider business mailing address

4510 EXECUTIVE DR PLAZA 5
SAN DIEGO CA
92121-3021
US

V. Phone/Fax

Practice location:
  • Phone: 858-452-3734
  • Fax: 858-452-6666
Mailing address:
  • Phone: 858-452-3734
  • Fax: 858-452-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC30994
License Number StateCA

VIII. Authorized Official

Name: DR. TODD PLUTCHOK
Title or Position: CEO
Credential: D.C.
Phone: 858-452-3734