1194998617 NPI number — KOMBERG CHIROPRACTIC

Table of content: (NPI 1194998617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194998617 NPI number — KOMBERG CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KOMBERG CHIROPRACTIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DOCTORS OF LA PALMA
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194998617
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7951 VALLEY VIEW ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA PALMA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90623-1848
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-994-1131
Provider Business Mailing Address Fax Number:
714-994-0130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7951 VALLEY VIEW ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA PALMA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90623-1848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-994-1131
Provider Business Practice Location Address Fax Number:
714-994-0130
Provider Enumeration Date:
04/04/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KOMBERG
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OWNER/CHIROPRACTOR
Authorized Official Telephone Number:
714-994-1131

Provider Taxonomy Codes

  • Taxonomy code: 111NX0800X , with the licence number:  DC16128 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)