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Organization
HEALTHSOURCE OF ANAHEIM INC
Active
Organization
HEALTHSOURCE OF ANAHEIM INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMAL F COOPER D C (PRESIDENT)
(714) 772-7100
Entity
Organization
Contact information
Practice address
716 S STATE COLLEGE BLVD, ANAHEIM, CA 92806-4526
(714) 772-7100
Mailing address
4760 DEVONPORT CIR, YORBA LINDA, CA 92887-2609
(714) 772-7100
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ05681Z
BLUE SHIELD GROUP ID
CA
Enumeration date
01/08/2007
Last updated
03/24/2009
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