MEDICARE: LLANTADA CHIROPRACTIC A PROFESSIONAL CORPORATION

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	COR2360	CA

General Provider Information

NPI Number	:	1649436486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LLANTADA CHIROPRACTIC A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	5252 BALBOA AVE STE 701
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-6930
Country	:	US
Telephone Number	:	858-384-6556
Fax Number	:	858-225-8320

Provider Business Practice Location Address
First Line	:	5252 BALBOA AVE STE 701
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-6930
Country	:	US
Telephone Number	:	858-384-6556
Fax Number	:	858-225-8320

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	RUMEL MENDOZA LLANTADA
Credential	:	DC
Telephone Number	:	858-384-6556

Provider Enumeration Date	:	07/31/2008
Last Update Date	:	04/29/2020

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