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General NPI Number Information
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NPI Number | 1245834951
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Entity Type | Organization
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Legal Business Name | UPCHURCH CHIROPRACTIC INC
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Dates
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Enumeration Date | 11/23/2020
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Last Update Date | 12/28/2020
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Provider Practice Location Address
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Address Line | 4901 MORENA BLVD STE 209A
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City | SAN DIEGO
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State | CA
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Zip | 92117-3571
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Country | US
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Telephone | 619-381-3759
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Fax |
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Provider Business Mailing Address
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Address Line | 2893 MCGRAW ST
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City | SAN DIEGO
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State | CA
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Zip | 92117-6044
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Country | US
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Telephone | 619-381-3759
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATTHEW RYAN UPCHURCH
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Credential | DC
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Telephone | 619-381-3759
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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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