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General NPI Number Information
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NPI Number | 1376789099
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Entity Type | Organization
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Legal Business Name | ERIC MUMBAUER ,D.C. A CHIROPRACTIC CORP
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Dates
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Enumeration Date | 12/30/2008
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Last Update Date | 12/30/2008
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Provider Practice Location Address
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Address Line | 601 S BRAND BLVD ST 103
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City | SAN FERNANDO
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State | CA
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Zip | 91340-4040
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Country | US
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Telephone | 818-365-0653
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Fax |
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Provider Business Mailing Address
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Address Line | 601 S BRAND BLVD ST 103
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City | SAN FERNANDO
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State | CA
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Zip | 91340-4040
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Country | US
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Telephone | 818-365-0653
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. ERIC PHILLIP MUMBAUER
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Credential | D.C.
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Telephone | 818-365-0653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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License Number | DC11343
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License Number State | CA
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