Healthcare Provider Details

I. General information

NPI: 1235123266
Provider Name (Legal Business Name): CHRIS WENDELL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 EL CAMINO REAL SUITE 104
TUSTIN CA
92780-3655
US

IV. Provider business mailing address

250 EL CAMINO REAL SUITE 104
TUSTIN CA
92780-3655
US

V. Phone/Fax

Practice location:
  • Phone: 714-508-9999
  • Fax: 714-508-0462
Mailing address:
  • Phone: 714-508-9999
  • Fax: 714-508-0462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberDC22260
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: