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General NPI Number Information
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NPI Number | 1679790653
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Entity Type | Organization
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Legal Business Name | DETERS CHIROPRACTIC CORP
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 12/13/2007
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Provider Practice Location Address
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Address Line | 2535 CAMINO DEL RIO S SUITE 225
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City | SAN DIEGO
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State | CA
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Zip | 92108-3754
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Country | US
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Telephone | 619-681-1919
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Fax | 619-681-1922
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Provider Business Mailing Address
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Address Line | 2535 CAMINO DEL RIO S SUITE 225
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City | SAN DIEGO
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State | CA
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Zip | 92108-3754
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Country | US
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Telephone | 619-681-1919
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Fax | 619-681-1922
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAYMOND LEROY DETERS III
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Credential | D.C.
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Telephone | 619-681-1919
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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 | DC20569
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License Number State | CA
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