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General NPI Number Information
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NPI Number | 1669659405
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Entity Type | Organization
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Legal Business Name | CORNEJO CHIROPRACTIC, INC
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Dates
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Enumeration Date | 01/23/2008
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Last Update Date | 01/23/2008
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Provider Practice Location Address
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Address Line | 237 N RIVERSIDE AVE
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City | RIALTO
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State | CA
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Zip | 92376-5923
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Country | US
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Telephone | 909-874-6640
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Fax |
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Provider Business Mailing Address
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Address Line | 237 N RIVERSIDE AVE
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City | RIALTO
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State | CA
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Zip | 92376-5923
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Country | US
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Telephone | 909-874-6640
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | VINICIO CORNEJO
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Credential | DC
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Telephone | 909-874-6640
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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 | DC26856
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License Number State | CA
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