Healthcare Provider Details

I. General information

NPI: 1477829885
Provider Name (Legal Business Name): UPLAND SPINE & REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 E 16TH ST SUITE 4
UPLAND CA
91784-9179
US

IV. Provider business mailing address

1125 E 16TH ST SUITE 4
UPLAND CA
91784-9179
US

V. Phone/Fax

Practice location:
  • Phone: 909-297-3531
  • Fax: 909-297-3004
Mailing address:
  • Phone: 909-297-3531
  • Fax: 909-297-3004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number32005
License Number StateCA

VIII. Authorized Official

Name: DR. SENKOSAL UY
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 909-297-3531