Provider Demographics
NPI:1942057013
Name:SCALCO CHIROPRACTIC A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SCALCO CHIROPRACTIC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOACHIM
Authorized Official - Last Name:SCALCO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:949-248-4888
Mailing Address - Street 1:408 WESTMINISTER AVENUE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4238
Mailing Address - Country:US
Mailing Address - Phone:949-270-6387
Mailing Address - Fax:949-449-8497
Practice Address - Street 1:408 WESTMINISTER AVENUE
Practice Address - Street 2:SUITE 12
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4238
Practice Address - Country:US
Practice Address - Phone:949-270-6387
Practice Address - Fax:949-449-8497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty