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General NPI Number Information
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NPI Number | 1578802013
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Entity Type | Organization
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Legal Business Name | KELLY T. MAI, A PROFESSIONAL CHIROPRACTIC CORPORATION
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Dates
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Enumeration Date | 02/04/2013
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Last Update Date | 02/04/2013
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Provider Practice Location Address
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Address Line | 12801-B MOUNTAIN AVE
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City | CHINO
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State | CA
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Zip | 91710
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Country | US
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Telephone | 909-464-8585
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Fax |
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Provider Business Mailing Address
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Address Line | 12801-B MOUNTAIN AVE
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City | CHINO
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State | CA
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Zip | 91710
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Country | US
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Telephone | 909-464-8585
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR AND ACUPUNCTURIST
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Name | MS. KELLY T MAI
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Credential | D.C., L.AC.
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Telephone | 909-464-8585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | AC9251
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | DC27481
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License Number State | CA
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