MEDICARE: MANSOUR CHIROPRACTIC INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	20299	CA

General Provider Information

NPI Number	:	1063683373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANSOUR CHIROPRACTIC INC.

Provider Business Mailing Address
First Line	:	14740 PIPELINE AVE
Second Line	:	SUITE A
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-1293
Country	:	US
Telephone Number	:	909-393-4545
Fax Number	:	909-393-3899

Provider Business Practice Location Address
First Line	:	14740 PIPELINE AVE
Second Line	:	SUITE A
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-1293
Country	:	US
Telephone Number	:	909-393-4545
Fax Number	:	909-393-3899

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALBERT D. MANSOUR
Credential	:	D.C.
Telephone Number	:	909-393-4545

Provider Enumeration Date	:	03/13/2008
Last Update Date	:	11/08/2021

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