Healthcare Provider Details

I. General information

NPI: 1730500042
Provider Name (Legal Business Name): MY CENTER FOR HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2014
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55887 YUCCA TRL
YUCCA VALLEY CA
92284-2546
US

IV. Provider business mailing address

55887 YUCCA TRL
YUCCA VALLEY CA
92284-2546
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-0453
  • Fax:
Mailing address:
  • Phone: 310-829-0453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC16824
License Number StateCA

VIII. Authorized Official

Name: DR. CHRISTIAN HERMANN REICHARDT
Title or Position: OWNER
Credential: D.C.
Phone: 310-600-8872