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General NPI Number Information
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NPI Number | 1871823054
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Entity Type | Organization
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Legal Business Name | PURE CHIROPRACTIC
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Dates
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Enumeration Date | 01/11/2010
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Last Update Date | 01/11/2010
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Provider Practice Location Address
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Address Line | 25136 HANCOCK AVE STE C
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City | MURRIETA
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State | CA
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Zip | 92562-0905
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Country | US
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Telephone | 951-461-4617
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Fax | 951-461-1403
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Provider Business Mailing Address
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Address Line | 25136 HANCOCK AVE STE C
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City | MURRIETA
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State | CA
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Zip | 92562-0905
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Country | US
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Telephone | 951-461-4617
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Fax | 951-461-1403
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | MR. ANTHONY MARTIN BECERRA
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Credential | D.C
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Telephone | 951-461-4617
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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 | DC0261810
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License Number State | CA
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