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General NPI Number Information
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NPI Number | 1376888123
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Entity Type | Organization
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Legal Business Name | FIX BODY GROUP
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Dates
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Enumeration Date | 12/05/2012
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 1010 UNIVERSITY AVE. C-201
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City | SAN DIEGO
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State | CA
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Zip | 92103
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Country | US
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Telephone | 619-295-9791
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Fax | 619-295-9792
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Provider Business Mailing Address
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Address Line | 1010 UNIVERSITY AVE. C.-201
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City | SAN DIEGO
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State | CA
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Zip | 92103
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Country | US
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Telephone | 619-295-9791
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Fax | 619-295-9792
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. SHAWN KEVIN ROBEK
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Credential | DC
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Telephone | 619-295-9791
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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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