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General NPI Number Information
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NPI Number | 1497138424
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Entity Type | Organization
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Legal Business Name | STARK FAMILY CHIROPRACTIC INC.
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Dates
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Enumeration Date | 07/08/2015
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Last Update Date | 10/26/2015
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Provider Practice Location Address
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Address Line | 17922 MAGNOLIA ST
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-5039
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Country | US
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Telephone | 714-887-7009
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Fax | 714-968-4384
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Provider Business Mailing Address
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Address Line | 17922 MAGNOLIA ST
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-5039
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Country | US
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Telephone | 714-887-7009
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Fax | 714-968-4384
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Authorized Official
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Title or Position | CHIROPRACTOR/ CO-OWNER
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Name | DR. LYSA NEMIROFF STARK
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Credential | DC
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Telephone | 714-887-7009
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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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