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General NPI Number Information
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NPI Number | 1730339540
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Entity Type | Organization
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Legal Business Name | ORTIZ CHIROPRACTIC A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/29/2008
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Last Update Date | 01/13/2017
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Provider Practice Location Address
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Address Line | 3833 BEDFORD CANYON RD SUITE C102
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City | CORONA
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State | CA
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Zip | 92883-0788
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Country | US
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Telephone | 951-808-9091
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Fax | 951-808-9702
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Provider Business Mailing Address
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Address Line | 3833 BEDFORD CANYON RD SUITE C102
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City | CORONA
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State | CA
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Zip | 92883-0788
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Country | US
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Telephone | 951-808-9091
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Fax | 951-808-9702
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Authorized Official
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Title or Position | OWNER
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Name | DR. VIC CARLO ORTIZ
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Credential | DC
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Telephone | 951-808-9091
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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 | DC26464
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License Number State | CA
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