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General NPI Number Information
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NPI Number | 1043370265
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Entity Type | Organization
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Legal Business Name | INTERNATIONAL CHIROPRACTIC CENTRE
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2588 MISSION ST SUITE 201
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-2592
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Country | US
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Telephone | 415-695-0654
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Fax |
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Provider Business Mailing Address
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Address Line | 2588 MISSION ST SUITE 201
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-2592
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Country | US
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Telephone | 415-695-0654
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MANUEL M. FONSECA
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Credential | DC
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Telephone | 415-695-0654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC24364
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | DC24364
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | DC24364
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License Number State | CA
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