Provider Demographics
NPI:1174546626
Name:POMMERENCK, DAVID AUGIE JR (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:AUGIE
Last Name:POMMERENCK
Suffix:JR
Gender:M
Credentials:DC
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Mailing Address - Street 1:25095 JEFFERSON AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-9107
Mailing Address - Country:US
Mailing Address - Phone:951-894-5006
Mailing Address - Fax:951-698-8749
Practice Address - Street 1:2049 PACIFIC COAST HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-2632
Practice Address - Country:US
Practice Address - Phone:310-530-7335
Practice Address - Fax:310-530-3681
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA16484111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33-0165618OtherTAX ID NO.
CA33-0165618OtherTAX ID NO.
CAT18346Medicare UPIN