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General NPI Number Information
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NPI Number | 1265074140
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Entity Type | Organization
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Legal Business Name | ABELLA-DESUYO CHIROPRACTIC
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Dates
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Enumeration Date | 10/12/2019
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Last Update Date | 09/18/2020
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Provider Practice Location Address
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Address Line | 30270 RANCHO VIEJO RD STE E
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-1556
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Country | US
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Telephone | 949-716-3930
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Fax |
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Provider Business Mailing Address
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Address Line | 30270 RANCHO VIEJO RD STE E
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-1556
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Country | US
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Telephone | 949-716-3930
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | JEANNA LYNN ABELLA-DESUYO
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Credential | DC
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Telephone | 209-559-4498
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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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