Healthcare Provider Details

I. General information

NPI: 1710788757
Provider Name (Legal Business Name): CRISTIAN LEIGSRING QUIROA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 CANOGA AVE STE 105
WOODLAND HILLS CA
91367-7793
US

IV. Provider business mailing address

1247 PETIT AVE APT 458
VENTURA CA
93004-2677
US

V. Phone/Fax

Practice location:
  • Phone: 818-222-1120
  • Fax:
Mailing address:
  • Phone: 805-796-4494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC37218
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: