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General NPI Number Information
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NPI Number | 1750570263
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Entity Type | Organization
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Legal Business Name | WIL UNTALAN JR. CHIROPRACTIC INC.
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Dates
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Enumeration Date | 10/20/2007
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Last Update Date | 10/20/2007
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Provider Practice Location Address
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Address Line | 5182 KATELLA AVE STE 102
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-2849
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Country | US
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Telephone | 562-799-7900
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Fax |
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Provider Business Mailing Address
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Address Line | 5182 KATELLA AVE STE 102
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-2849
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Country | US
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Telephone | 562-799-7900
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. WILFREDO UNTALAN JR.
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Credential | DC
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Telephone | 562-799-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | DC28547
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License Number State | CA
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