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General NPI Number Information
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NPI Number | 1548512270
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Entity Type | Organization
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Legal Business Name | IGNACIO CHIROPRACTIC, PROF. CORP.
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Dates
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Enumeration Date | 10/04/2012
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Last Update Date | 10/18/2013
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Provider Practice Location Address
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Address Line | 5673 W LAS POSITAS BLVD SUITE 215
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City | PLEASANTON
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State | CA
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Zip | 94588-4077
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Country | US
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Telephone | 925-225-0500
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Fax | 925-225-0505
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Provider Business Mailing Address
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Address Line | 5673 W LAS POSITAS BLVD SUITE 215
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City | PLEASANTON
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State | CA
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Zip | 94588-4077
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Country | US
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Telephone | 925-225-0500
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Fax | 925-225-0505
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRYAN IGNACIO
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Credential | D.C.
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Telephone | 925-484-1957
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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 | 32192
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License Number State | CA
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