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General NPI Number Information
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NPI Number | 1518407592
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Entity Type | Organization
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Legal Business Name | ERIC G MORTENSEN CHIROPRACTIC INC
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Dates
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Enumeration Date | 02/24/2017
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Last Update Date | 02/24/2017
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Provider Practice Location Address
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Address Line | 4517 MARKET ST SUITE 1
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City | VENTURA
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State | CA
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Zip | 93003-7839
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Country | US
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Telephone | 805-650-5929
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Fax | 805-650-5947
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Provider Business Mailing Address
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Address Line | 4517 MARKET ST SUITE 1
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City | VENTURA
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State | CA
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Zip | 93003-7839
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Country | US
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Telephone | 805-650-5929
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Fax | 805-650-5947
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Authorized Official
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Title or Position | OWNER
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Name | ERIC G MORTENSEN
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Credential | DC
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Telephone | 805-650-5929
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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 | DC24888
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License Number State | CA
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