Healthcare Provider Details

I. General information

NPI: 1881758258
Provider Name (Legal Business Name): PUJAYANA CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 FREMONT AVE STE A
SOUTH PASADENA CA
91030-3224
US

IV. Provider business mailing address

1017 FREMONT AVE STE A
SOUTH PASADENA CA
91030-3224
US

V. Phone/Fax

Practice location:
  • Phone: 626-441-4888
  • Fax: 626-441-5680
Mailing address:
  • Phone: 626-441-4888
  • Fax: 626-441-5680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC27517
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC25383
License Number StateCA

VIII. Authorized Official

Name: DR. CHRISTINE SUE SMITH
Title or Position: VP SECRETARY
Credential: D.C.
Phone: 626-441-4888