1467963462 NPI number — TARDGUILA CHIROPRACTIC PROFESSIONAL CORP.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467963462 NPI number — TARDGUILA CHIROPRACTIC PROFESSIONAL CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TARDGUILA CHIROPRACTIC PROFESSIONAL CORP.
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:
Provider Other Organization Name Type Code:
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:
1467963462
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14650 AVIATION BLVD # 100B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAWTHORNE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90250-6668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-961-8792
Provider Business Mailing Address Fax Number:
310-325-3041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14650 AVIATION BLVD # 100B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAWTHORNE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90250-6668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-961-8792
Provider Business Practice Location Address Fax Number:
310-325-3041
Provider Enumeration Date:
10/17/2017

Additional Information

Authorized Official

Authorized Official Last Name:
TARDAGUILA
Authorized Official First Name:
GREORY
Authorized Official Middle Name:
STEVEN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
310-961-8792

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC19626 , 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)





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