Provider Demographics
NPI:1316175466
Name:CHIVABUNDITT, PAUL WATCHARA (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WATCHARA
Last Name:CHIVABUNDITT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3662 KATELLA AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720
Mailing Address - Country:US
Mailing Address - Phone:909-859-5327
Mailing Address - Fax:
Practice Address - Street 1:3662 KATELLA AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720
Practice Address - Country:US
Practice Address - Phone:714-576-0457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36407111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor