Healthcare Provider Details

I. General information

NPI: 1518618495
Provider Name (Legal Business Name): COMMUNITY CHIROPRACTIC GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 S COURT ST
VISALIA CA
93277-4962
US

IV. Provider business mailing address

1628 S COURT ST
VISALIA CA
93277-4962
US

V. Phone/Fax

Practice location:
  • Phone: 559-627-1710
  • Fax: 559-627-2510
Mailing address:
  • Phone: 559-627-1710
  • Fax: 559-627-2510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW SAMUEL LOPEZ
Title or Position: PRESIDENT
Credential: DC
Phone: 559-627-1710