Provider Demographics
NPI:1366610354
Name:MONAHAN CHIROPRACTIC CORP
Entity type:Organization
Organization Name:MONAHAN CHIROPRACTIC CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MONAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:909-598-7868
Mailing Address - Street 1:3220 S BREA CANYON RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765
Mailing Address - Country:US
Mailing Address - Phone:909-598-7868
Mailing Address - Fax:909-598-4428
Practice Address - Street 1:3220 S BREA CANYON RD
Practice Address - Street 2:SUITE F
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765
Practice Address - Country:US
Practice Address - Phone:909-598-7868
Practice Address - Fax:909-598-4428
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHIRO PLUS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC19355AMedicare UPIN