Provider Demographics
NPI:1124815980
Name:PURA VIDA CHIROPRACTIC
Entity type:Organization
Organization Name:PURA VIDA CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:GUADALUPE
Authorized Official - Last Name:LOERA SERA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-641-4396
Mailing Address - Street 1:31682 VIA VENTANA
Mailing Address - Street 2:
Mailing Address - City:THOUSAND PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92276-3374
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2150 E TAHQUITZ CANYON WAY STE 5
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6817
Practice Address - Country:US
Practice Address - Phone:760-836-6555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service