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NPI Code Detail

MEDICARE: BOUWHUIS CHIROPRACTIC CORP

MEDICARE: BOUWHUIS CHIROPRACTIC CORP
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
1111NS0005XSports Physician Chiropractor31527CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
145-1538580OTHERFORMER NPI (WHEN PRACTICED AS SOLE PROPRIETOR)
2CA-31527OTHERCALICENSE TO PRACTICE CHIROPRACTIC

General Provider Information

NPI Number : 1275979577
Entity Type Code : Organization
Provider Name (Legal Business Name) : BOUWHUIS CHIROPRACTIC CORP
Provider Business Mailing Address
First Line : 24582 DEL PRADO STE H
Second Line :
City : DANA POINT
State : CA
Zip : 92629-3821
Country : US
Telephone Number : 949-487-2722
Fax Number : 949-487-2723
Provider Business Practice Location Address
First Line : 24582 DEL PRADO STE H
Second Line :
City : DANA POINT
State : CA
Zip : 92629-3821
Country : US
Telephone Number : 949-487-2722
Fax Number : 949-487-2723
Authorized Official
Title or Position : OWNER
Name : DUSTIN J BOUWHUIS
Credential : D.C.
Telephone Number : 949-487-2722
Provider Enumeration Date : 05/14/2013
Last Update Date : 05/14/2013

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Directions to “BOUWHUIS CHIROPRACTIC CORP ” Practice Location

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