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General NPI Number Information
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NPI Number | 1083128094
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Entity Type | Individual
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Provider Name | MIGUEL PARK DC.
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Gender | Male
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Dates
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Enumeration Date | 11/29/2017
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Last Update Date | 11/29/2017
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Provider Practice Location Address
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Address Line | 14671 RAMONA AVE
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City | CHINO
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State | CA
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Zip | 91710-5648
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Country | US
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Telephone | 909-606-7999
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Fax | 909-606-8999
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Provider Business Mailing Address
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Address Line | 14671 RAMONA AVE
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City | CHINO
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State | CA
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Zip | 91710-5648
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Country | US
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Telephone | 909-606-7999
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Fax | 909-606-8999
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DC31244
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License Number State | CA
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