Organization
CHIROSSAGE WELLNESS,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH ILLSON CHIROPRACTOR (PRESIDENT)
(949) 326-7007
Entity
Organization
Contact information
Practice address
11 MAREBLU STE 130, ALISO VIEJO, CA 92656-3053
(949) 326-7007
Mailing address
11 MAREBLU STE 130, ALISO VIEJO, CA 92656-3053
(949) 326-7007
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
17202
CA
Other
Enumeration date
07/03/2018
Last updated
07/03/2018
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