Healthcare Provider Details

I. General information

NPI: 1992188320
Provider Name (Legal Business Name): PACIFIC CHIROPRACTIC & WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 E MAIN ST STE 106
TUSTIN CA
92780-4459
US

IV. Provider business mailing address

180 E MAIN ST STE 106
TUSTIN CA
92780-4459
US

V. Phone/Fax

Practice location:
  • Phone: 714-505-1901
  • Fax: 714-884-3391
Mailing address:
  • Phone: 714-505-1901
  • Fax: 714-884-3391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number33325
License Number StateCA

VIII. Authorized Official

Name: DR. FERESHTEH SAEEDA
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: DC
Phone: 714-505-1901