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General NPI Number Information
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NPI Number | 1508239146
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Entity Type | Organization
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Legal Business Name | BODY AND MIND CHIROPRACTIC
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Dates
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Enumeration Date | 11/04/2015
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Last Update Date | 11/05/2015
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Provider Practice Location Address
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Address Line | 3811 SCHAEFER AVE STE. E
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City | CHINO
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State | CA
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Zip | 91710-5400
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Country | US
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Telephone | 909-591-1300
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Fax | 909-591-1377
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Provider Business Mailing Address
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Address Line | 3811 SCHAEFER AVE STE. E
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City | CHINO
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State | CA
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Zip | 91710-5400
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Country | US
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Telephone | 909-591-1300
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Fax | 909-591-1377
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Authorized Official
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Title or Position | CEO
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Name | DR. HOAN VU
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Credential | D.C
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Telephone | 909-591-1300
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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 | DC33407
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License Number State | CA
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