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General NPI Number Information
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NPI Number | 1932397619
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Entity Type | Organization
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Legal Business Name | CORREA CHIROPRACTIC & WELLNESS CENTER, INC.
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 777 PISMO ST
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-3949
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Country | US
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Telephone | 805-674-0848
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Fax |
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Provider Business Mailing Address
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Address Line | 777 PISMO ST
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-3949
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Country | US
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Telephone | 805-674-0848
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOEL CORREA
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Credential | D.C.
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Telephone | 805-674-0848
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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 | DC28470
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License Number State | CA
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