Provider Demographics
NPI:1447906284
Name:VANDERSCHELDEN CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:VANDERSCHELDEN CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-515-1975
Mailing Address - Street 1:1601 DOVE ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2433
Mailing Address - Country:US
Mailing Address - Phone:949-631-0200
Mailing Address - Fax:
Practice Address - Street 1:1601 DOVE ST
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2433
Practice Address - Country:US
Practice Address - Phone:949-631-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty