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General NPI Number Information
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NPI Number | 1104938349
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Entity Type | Organization
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Legal Business Name | KWAN-OCASIO CHIROPRACTIC CORPORATION
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 11/24/2009
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Provider Practice Location Address
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Address Line | 236 W MOUNTAIN ST SUITE 107
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City | PASADENA
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State | CA
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Zip | 91103-2967
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Country | US
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Telephone | 626-449-0900
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Fax | 626-449-0800
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Provider Business Mailing Address
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Address Line | 130 COOK AVE STE 102
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City | PASADENA
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State | CA
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Zip | 91107-7323
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Country | US
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Telephone | 626-796-8800
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Fax | 626-796-8811
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Authorized Official
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Title or Position | CEO
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Name | DANIELA KWAN OCASIO
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Credential | D.C., A.T.C.
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Telephone | 626-449-0900
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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 | DC30040
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC28110
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License Number State | CA
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