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General NPI Number Information
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NPI Number | 1669797833
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Entity Type | Organization
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Legal Business Name | NEUROLOGICAL HEALING, INC.
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Dates
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Enumeration Date | 03/31/2010
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Last Update Date | 03/31/2010
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Provider Practice Location Address
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Address Line | 2835 CAMINO DEL RIO S STE 110
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City | SAN DIEGO
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State | CA
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Zip | 92108-3825
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Country | US
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Telephone | 619-630-9153
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Fax | 619-550-4671
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Provider Business Mailing Address
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Address Line | 2835 CAMINO DEL RIO S STE 110
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City | SAN DIEGO
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State | CA
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Zip | 92108-3825
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Country | US
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Telephone | 619-630-9153
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Fax | 619-550-4671
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DIRK HANS KANCILIA
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Credential | D.C
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Telephone | 619-630-9153
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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 | DC27281
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC016440
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License Number State | CA
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