| Antelope Valley Spinal Care Medical Corp | |
|
42283 10th St W Suite 107 Lancaster CA 93534-7073 | |
| (661) 949-9655 | |
| Not Available |
| Full Name | Antelope Valley Spinal Care Medical Corp |
|---|---|
| Speciality | Clinic/Center |
| Location | 42283 10th St W, Lancaster, California |
| Authorized Official Name and Position | Harry Engel (ADMINISTRATOR) |
| Authorized Official Contact | 6619499655 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Antelope Valley Spinal Care Medical Corp 42283 10th St W Suite 107 Lancaster CA 93534-7073 Ph: () - | Antelope Valley Spinal Care Medical Corp 42283 10th St W Suite 107 Lancaster CA 93534-7073 Ph: (661) 949-9655 |
| NPI Number | 1205860558 |
|---|---|
| Provider Enumeration Date | 07/11/2006 |
| Last Update Date | 11/07/2017 |
| Medicare PECOS PAC ID | 0547167249 |
|---|---|
| Medicare Enrollment ID | O20031218000805 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205860558 | NPI | - | NPPES |
| W15049 | Other | CA | MEDICARE GROUP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Theodore J Magnuson |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1497775654 PECOS PAC ID: 3971544370 Enrollment ID: I20050516000952 |
| Provider Name | Suzanne Rita Frye |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1063432227 PECOS PAC ID: 6608773312 Enrollment ID: I20120203000756 |
| Provider Name | Judith Lagaly |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1497808992 PECOS PAC ID: 3274858147 Enrollment ID: I20150217001950 |
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