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General NPI Number Information
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NPI Number | 1205890712
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Entity Type | Organization
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Legal Business Name | MOLINA CHIROPRACTIC PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/12/2006
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Last Update Date | 08/12/2015
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Provider Practice Location Address
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Address Line | 647 CAMINO DE LOS MARES SUITE 226
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-2825
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Country | US
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Telephone | 949-248-2826
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Fax | 949-248-2815
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Provider Business Mailing Address
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Address Line | 647 CAMINO DE LOS MARES 226 POST STOP108-90
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-2825
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Country | US
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Telephone | 949-248-2826
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Fax | 949-248-2815
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. NANCY MOLINA
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Credential | D.C.
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Telephone | 949-248-2826
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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 |
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License Number State |
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