=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851160444
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEACH WELLNESS CHIROPRACTIC INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2023
-----------------------------------------------------
Last Update Date | 07/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2211 E LINCOLN AVE
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92806-4108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-774-2455
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 307 E 56TH ST
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90805-4603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-851-2074
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR/OWNER
-----------------------------------------------------
Name | JORGE LUIS PEREZ
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 714-851-2074
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------