Organization
ANTONISSEN FAMILY CHIROPRACTIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRANDON ANTONISSEN DC (PRESIDENT)
(949) 228-1147
Entity
Organization
Contact information
Practice address
33081 CAMINO CAPISTRANO, SAN JUAN CAPISTRANO, CA 92675-4868
(949) 228-1147
Mailing address
1968 S COAST HWY STE 1073, LAGUNA BEACH, CA 92651-3681
(949) 228-1147
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CB304299
—
CA
Enumeration date
11/06/2018
Last updated
03/20/2023
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