Provider Demographics
NPI:1215266937
Name:LADERA CHIROPRACTIC AND WELLNESS, KHREICH AND CISNEROS CORP
Entity type:Organization
Organization Name:LADERA CHIROPRACTIC AND WELLNESS, KHREICH AND CISNEROS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN-PIERRE
Authorized Official - Middle Name:NABIH
Authorized Official - Last Name:KHREICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC, QME
Authorized Official - Phone:949-429-8787
Mailing Address - Street 1:1701 CORPORATE DR STE C5
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-2126
Mailing Address - Country:US
Mailing Address - Phone:949-429-8787
Mailing Address - Fax:949-429-8077
Practice Address - Street 1:1701 CORPORATE DR STE C5
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-2126
Practice Address - Country:US
Practice Address - Phone:949-429-8787
Practice Address - Fax:949-429-8077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty