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General NPI Number Information
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NPI Number | 1144550450
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Entity Type | Organization
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Legal Business Name | SURACES CHIROPRACTIC BACK ALERT CLINIC, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/08/2010
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Last Update Date | 08/04/2016
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Provider Practice Location Address
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Address Line | 643 S BUTTE ST
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City | SAN PEDRO
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State | CA
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Zip | 90732-3510
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Country | US
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Telephone | 310-831-5700
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Fax | 310-831-5700
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Provider Business Mailing Address
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Address Line | 643 S BUTTE ST
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City | SAN PEDRO
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State | CA
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Zip | 90732-3510
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Country | US
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Telephone | 310-831-5700
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Fax | 310-831-5700
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. VINCENT J. SURACE
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Credential | D.C.
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Telephone | 310-831-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 10283
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License Number State | CA
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