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General NPI Number Information
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NPI Number | 1154435154
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Entity Type | Organization
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Legal Business Name | MISSION LAKE CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3600 LIME ST STE 210
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City | RIVERSIDE
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State | CA
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Zip | 92501-0900
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Country | US
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Telephone | 951-683-6600
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Fax | 951-683-6644
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Provider Business Mailing Address
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Address Line | 3600 LIME ST STE 210
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City | RIVERSIDE
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State | CA
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Zip | 92501-0900
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Country | US
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Telephone | 951-683-6600
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Fax | 951-683-6644
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Authorized Official
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Title or Position | CO-OWNER/ DOCTOR
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Name | DR. ALI KHAMSEI
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Credential | D.C.
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Telephone | 951-683-6600
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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 | DC28966
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License Number State | CA
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