=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013418946
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEREZ CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2018
-----------------------------------------------------
Last Update Date | 02/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2065 S ESCONDIDO BLVD STE 105
-----------------------------------------------------
City | ESCONDIDO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92025-8221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-565-2225
-----------------------------------------------------
Fax | 760-690-2212
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2065 S ESCONDIDO BLVD STE 105
-----------------------------------------------------
City | ESCONDIDO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92025-8221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-565-2225
-----------------------------------------------------
Fax | 760-690-2212
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROSANNA R PEREZ
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 760-565-2225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC-30815
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------