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General NPI Number Information
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NPI Number | 1871942334
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Entity Type | Organization
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Legal Business Name | CORINNE ETHEL DADIVAS
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Dates
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Enumeration Date | 06/06/2016
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Last Update Date | 06/06/2016
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Provider Practice Location Address
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Address Line | 1501 WESTCLIFF DR SUITE 303
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-5517
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Country | US
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Telephone | 949-764-9102
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Fax | 949-764-1743
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Provider Business Mailing Address
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Address Line | 1501 WESTCLIFF DR SUITE 303
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-5517
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Country | US
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Telephone | 949-764-9102
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Fax | 949-764-1743
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. CORINNE ETHEL DADIVAS
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Credential | DC
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Telephone | 714-686-9704
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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 | DC29415
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License Number State | CA
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