| San Clemente Vitality Center Inc. | |
|
647 Camino De Los Mares, Ste 218, San Clemente, CA 92673-2807 | |
| (949) 441-7755 | |
| (949) 598-9990 |
| Full Name | San Clemente Vitality Center Inc. |
|---|---|
| Type | Facility |
| Speciality | Chiropractor |
| Location | 647 Camino De Los Mares, San Clemente, California |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134773971 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111N00000X | Chiropractor | (* (Not Available)) | Primary |
| Provider Name | Burton Leland Wagner |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1245659507 PECOS PAC ID: 6901128164 Enrollment ID: I20141209000734 |
| Mailing Address | Practice Location Address |
|---|---|
| San Clemente Vitality Center Inc. 15520 Rockfield Blvd, #a200, Irvine, CA 92618-6705 Ph: (949) 598-9999 | San Clemente Vitality Center Inc. 647 Camino De Los Mares, Ste 218, San Clemente, CA 92673-2807 Ph: (949) 441-7755 |
Sepideh Forstie Chiropractor Medicare: Not Enrolled in Medicare Practice Location: 1300 Avenida Vista Hermosa, Ste 100, San Clemente, CA 92673 Phone: 949-939-2928 | |
Dr. Cynthia Shoga, D.C Chiropractor Medicare: Not Enrolled in Medicare Practice Location: 125 W Avenida Palizada, San Clemente, CA 92672 Phone: 949-492-3532 | |
Costa Lifestlye Medicine Chiropractor Medicare: Medicare Enrolled Practice Location: 181 Avenida Vaquero, Ste D, San Clemente, CA 92672 Phone: 949-218-4750 Fax: 949-276-7393 | |
Dr. Sepideh Forstie, D.C. Chiropractor Medicare: Not Enrolled in Medicare Practice Location: 1300 Avenida Vista Hermosa, Suite 100, San Clemente, CA 92673 Phone: 949-939-2928 | |
Dr. Nancy Molina, D.C. Chiropractor Medicare: Medicare Enrolled Practice Location: 647 Camino De Los Mares 226, San Clemente, CA 92673 Phone: 949-248-2826 Fax: 949-248-2815 | |
Wayne Greathouse, DC Chiropractor Medicare: Not Enrolled in Medicare Practice Location: 130 Avenida Cabrillo, Ste C, San Clemente, CA 92672 Phone: 949-481-8282 Fax: 949-218-6303 | |
David Ahrens Chiropractor Medicare: Not Enrolled in Medicare Practice Location: 629 Camino De Los Mares, Suite 104, San Clemente, CA 92673 Phone: 714-240-1334 Fax: 949-240-4434 |