=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871712406
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RATZLAFF CHIROPRACTIC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27725 SANTA MARGARITA PKWY SUITE 120
-----------------------------------------------------
City | MISSION VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92691-6704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-855-1887
-----------------------------------------------------
Fax | 949-855-3213
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27725 SANTA MARGARITA PKWY SUITE 120
-----------------------------------------------------
City | MISSION VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92691-6704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-855-1887
-----------------------------------------------------
Fax | 949-855-3213
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JEROMY DEAN RATZLAFF
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 949-855-1887
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 29293
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------