Provider Demographics
NPI:1932539848
Name:FITNESS CHIROPRACTIC
Entity type:Organization
Organization Name:FITNESS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN-PIERRE
Authorized Official - Middle Name:
Authorized Official - Last Name:KHREICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-785-9247
Mailing Address - Street 1:100 OCEANGATE
Mailing Address - Street 2:STE P 280
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4390
Mailing Address - Country:US
Mailing Address - Phone:562-590-7349
Mailing Address - Fax:
Practice Address - Street 1:100 OCEANGATE
Practice Address - Street 2:STE P 280
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4312
Practice Address - Country:US
Practice Address - Phone:562-590-7349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27245111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty