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General NPI Number Information
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NPI Number | 1316521065
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Entity Type | Organization
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Legal Business Name | 100 PERCENT CHIROPRACTIC LIVINGOOD, INC
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Dates
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Enumeration Date | 05/10/2021
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Last Update Date | 03/03/2022
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Provider Practice Location Address
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Address Line | 129-131 W. CALIFORNIA BLVD.
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City | PASADENA
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State | CA
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Zip | 91105
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Country | US
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Telephone | 266-529-3153
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Fax |
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Provider Business Mailing Address
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Address Line | 18025 CALLE AMBIENTE STE 204
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City | RANCHO SANTA FE
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State | CA
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Zip | 92067-9549
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Country | US
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Telephone | 719-271-0895
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Fax |
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Authorized Official
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Title or Position | ONBOARDING
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Name | ROXANNE TRUJILLO
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Credential |
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Telephone | 719-217-0895
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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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