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General NPI Number Information
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NPI Number | 1992979348
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Entity Type | Organization
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Legal Business Name | FREMONT FAMILY & SPORTS CHIROPRACTIC
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 39813 PASEO PADRE PKWY
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City | FREMONT
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State | CA
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Zip | 94538-2974
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Country | US
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Telephone | 510-440-0410
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Fax | 510-440-0411
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Provider Business Mailing Address
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Address Line | 39813 PASEO PADRE PKWY
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City | FREMONT
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State | CA
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Zip | 94538-2974
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Country | US
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Telephone | 510-440-0410
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Fax | 510-440-0411
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Authorized Official
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Title or Position | OWNER, CHIROPRACTOR
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Name | DR. MELANIE SISON CORONEL
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Credential | D.C.
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Telephone | 510-440-0410
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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 | 30389
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License Number State | CA
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