=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366123101
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORDS-ESPOSITO CHIROPRACTIC, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2023
-----------------------------------------------------
Last Update Date | 07/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28924 S WESTERN AVE STE 210
-----------------------------------------------------
City | RANCHO PALOS VERDES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90275-0814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-326-2922
-----------------------------------------------------
Fax | 310-325-0899
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28924 S WESTERN AVE STE 210
-----------------------------------------------------
City | RANCHO PALOS VERDES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90275-0814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-326-2922
-----------------------------------------------------
Fax | 310-325-0899
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CHIROPRACTOR
-----------------------------------------------------
Name | TIM ESPOSITO
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 310-326-2922
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NS0005X
-----------------------------------------------------
Taxonomy Name | Sports Physician Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------