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General NPI Number Information
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NPI Number | 1174046874
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Entity Type | Organization
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Legal Business Name | RUSSELL THOMPSON CHIROPRACTIC INC
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Dates
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Enumeration Date | 07/25/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 629 CAMINO DE LOS MARES, STE. 104
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City | SAN CLEMENTE
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State | CA
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Zip | 92672
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Country | US
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Telephone | 949-240-1334
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Fax | 949-240-4434
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Provider Business Mailing Address
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Address Line | 629 CAMINO DE LOS MARES STE 104
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-2829
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Country | US
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Telephone | 949-240-1334
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Fax | 949-240-4434
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CATHY STABLEY
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Credential |
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Telephone | 949-240-1334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | DC31976
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License Number State | CA
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