| Dr. Porter Sports Chiropractic & Wellness Inc. | |
|
2345 Erringer Rd Ste 210 Simi Valley CA 93065-2250 | |
| (805) 582-0770 | |
| (805) 582-0003 |
| Full Name | Dr. Porter Sports Chiropractic & Wellness Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 2345 Erringer Rd Ste 210, Simi Valley, California |
| Authorized Official Name and Position | Elena M Porter (CHIROPRACTOR) |
| Authorized Official Contact | 8055820770 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Porter Sports Chiropractic & Wellness Inc. 2345 Erringer Rd Ste 210 Simi Valley CA 93065-2250 Ph: (805) 582-0770 | Dr. Porter Sports Chiropractic & Wellness Inc. 2345 Erringer Rd Ste 210 Simi Valley CA 93065-2250 Ph: (805) 582-0770 |
| NPI Number | 1770076796 |
|---|---|
| Provider Enumeration Date | 06/13/2018 |
| Last Update Date | 06/13/2018 |
| Medicare PECOS PAC ID | 1355687401 |
|---|---|
| Medicare Enrollment ID | O20190109003020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770076796 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 31635 (California) | Primary |
| Provider Name | Elena Marie Porter |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1922325075 PECOS PAC ID: 9032365770 Enrollment ID: I20120810000683 |
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