Provider Demographics
NPI:1063945210
Name:MANSOUR CHIROPRACTIC GROUP, INC.
Entity type:Organization
Organization Name:MANSOUR CHIROPRACTIC GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-916-0954
Mailing Address - Street 1:17050 BUSHARD ST STE 205
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2832
Mailing Address - Country:US
Mailing Address - Phone:714-916-0954
Mailing Address - Fax:
Practice Address - Street 1:17050 BUSHARD ST STE 205
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2832
Practice Address - Country:US
Practice Address - Phone:714-916-0954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty