Provider Demographics
NPI:1063109270
Name:JONATHAN CARLOS CHIROPRACTIC PC
Entity type:Organization
Organization Name:JONATHAN CARLOS CHIROPRACTIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN ANTHONY
Authorized Official - Middle Name:ENRIQUEZ
Authorized Official - Last Name:CARLOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-573-8341
Mailing Address - Street 1:1403 LOMITA BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-2085
Mailing Address - Country:US
Mailing Address - Phone:818-573-8341
Mailing Address - Fax:
Practice Address - Street 1:1403 LOMITA BLVD STE 301
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-2085
Practice Address - Country:US
Practice Address - Phone:818-573-8341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty