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General NPI Number Information
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NPI Number | 1396983292
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Entity Type | Organization
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Legal Business Name | CANTONG ACTIVE LIFE CHIROPRACTIC INC
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Dates
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Enumeration Date | 01/30/2009
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Last Update Date | 01/30/2009
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Provider Practice Location Address
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Address Line | 3540 WILSHIRE BLVD SUITE 620
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City | LOS ANGELES
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State | CA
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Zip | 90010-2350
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Country | US
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Telephone | 213-487-4621
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Fax | 213-487-7621
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Provider Business Mailing Address
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Address Line | 3540 WILSHIRE BLVD SUITE 620
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City | LOS ANGELES
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State | CA
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Zip | 90010-2307
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Country | US
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Telephone | 213-487-4621
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Fax | 213-487-7621
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Authorized Official
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Title or Position | CEO
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Name | DR. DAVID ENRIQUE CANTONG
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Credential | D.C.
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Telephone | 213-700-4819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | DC21916
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License Number State | CA
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