Basic Information
| Provider Information | |||||||||
| NPI: | 1699105544 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WESTERN UNITED MEDICAL CARE INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1414 S AZUSA AVE STE B-6 | ||||||||
| Address2: | |||||||||
| City: | WEST COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917914088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269178706 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1414 S AZUSA AVE STE B-5 | ||||||||
| Address2: | |||||||||
| City: | WEST COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917914088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269178706 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2013 | ||||||||
| LastUpdateDate: | 11/26/2013 | ||||||||
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| AuthorizedOfficialLastName: | MATIN | ||||||||
| AuthorizedOfficialFirstName: | MAHMOUD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIROPRACTOR | ||||||||
| AuthorizedOfficialTelephone: | 6269178706 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111NI0900X | DC23316 | CA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor | Internist | 111NI0900X | A448861 | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor | Internist |
No ID Information.