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General NPI Number Information
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NPI Number | 1639301880
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Entity Type | Organization
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Legal Business Name | CALIFORNIA SCOLIOSIS CENTER
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Dates
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Enumeration Date | 08/20/2009
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Last Update Date | 08/20/2009
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Provider Practice Location Address
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Address Line | 12721 NEWPORT AVE SUITE 2
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City | TUSTIN
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State | CA
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Zip | 92780-8030
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Country | US
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Telephone | 714-544-9789
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Fax | 714-544-9792
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Provider Business Mailing Address
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Address Line | 12721 NEWPORT AVE SUITE 2
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City | TUSTIN
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State | CA
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Zip | 92780-8030
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Country | US
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Telephone | 714-544-9789
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Fax | 714-544-9792
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID RICHARD GORRIE
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Credential | D.C.
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Telephone | 714-544-9789
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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 | DC20197
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License Number State | CA
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