=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932654761
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAPITAL MEDICAL GROUP PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2016
-----------------------------------------------------
Last Update Date | 08/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7007 WASHINGTON AVE STE 350
-----------------------------------------------------
City | WHITTIER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90602-3611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-632-1027
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1550 N D ST SUITE F
-----------------------------------------------------
City | SAN BERNARDINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92405-4720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-632-1027
-----------------------------------------------------
Fax | 562-632-1029
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | DR. CHRISTOPHER ARMSTRONG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 619-200-3233
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NX0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Chiropractor
-----------------------------------------------------
License Number | DC22101
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------