Healthcare Provider Details

I. General information

NPI: 1801078290
Provider Name (Legal Business Name): GEORGE KYRIOPOULOS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W ESLPLANADE SUITE B
SAN JACINTO CA
92582
US

IV. Provider business mailing address

711 W ESLPLANADE SUITE B
SAN JACINTO CA
92582
US

V. Phone/Fax

Practice location:
  • Phone: 951-654-6263
  • Fax:
Mailing address:
  • Phone: 951-654-6263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberDC0157070
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC0157070
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberDC0157070
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC0157070
License Number StateCA

VIII. Authorized Official

Name: GEORGE KYRIOPOULOS
Title or Position: OWNER
Credential: DC
Phone: 951-654-6263