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General NPI Number Information
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NPI Number | 1053507947
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Entity Type | Organization
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Legal Business Name | LOPEZ FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 09/24/2007
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Last Update Date | 09/24/2007
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Provider Practice Location Address
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Address Line | 266 MOBIL AVE STE 108
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City | CAMARILLO
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State | CA
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Zip | 93010-6371
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Country | US
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Telephone | 805-482-0105
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Fax |
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Provider Business Mailing Address
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Address Line | 266 MOBIL AVE STE 108
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City | CAMARILLO
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State | CA
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Zip | 93010-6371
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Country | US
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Telephone | 805-482-0105
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | MRS. NICOLE MARIE LOPEZ
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Credential |
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Telephone | 805-482-0105
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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 | DC28513
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License Number State | CA
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