Healthcare Provider Details

I. General information

NPI: 1669166757
Provider Name (Legal Business Name): SONG CHIROPRACTIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29377 RANCHO CALIFORNIA RD STE 106
TEMECULA CA
92591-5206
US

IV. Provider business mailing address

29377 RANCHO CALIFORNIA RD STE 106
TEMECULA CA
92591-5206
US

V. Phone/Fax

Practice location:
  • Phone: 951-676-8686
  • Fax:
Mailing address:
  • Phone: 951-676-8686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: ISAAC SONG
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 909-809-0128