Provider Demographics
NPI:1194948067
Name:A PROFESSIONAL CHIROPRACTIC CORP.
Entity type:Organization
Organization Name:A PROFESSIONAL CHIROPRACTIC CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:VON BORSTEL
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:562-866-3340
Mailing Address - Street 1:5220 CLARK AVE.
Mailing Address - Street 2:SUITE 445
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712
Mailing Address - Country:US
Mailing Address - Phone:562-866-3340
Mailing Address - Fax:562-804-0499
Practice Address - Street 1:5220 CLARK AVE.
Practice Address - Street 2:SUITE 445
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712
Practice Address - Country:US
Practice Address - Phone:562-866-3340
Practice Address - Fax:562-804-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty