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General NPI Number Information
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NPI Number | 1972051514
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Entity Type | Organization
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Legal Business Name | TRESTLES CHIROPRACTIC AN ANDERSON CORPORATION
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Dates
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Enumeration Date | 09/12/2016
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 653 CAMINO DE LOS MARES STE 100
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-2808
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Country | US
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Telephone | 949-284-6620
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Fax | 949-284-0598
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Provider Business Mailing Address
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Address Line | 653 CAMINO DE LOS MARES STE 100
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-2808
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Country | US
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Telephone | 949-284-6620
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Fax | 949-284-0598
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Authorized Official
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Title or Position | OWNER
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Name | DR. RYAN ROGER ANDERSON
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Credential | D.C.
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Telephone | 949-284-6620
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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 | 32637
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License Number State | CA
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