Individual
CHAMPION WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1905 E 17TH ST, 309, SANTA ANA, CA 92705-8628
(714) 543-0425
(714) 543-2062
Mailing address
1905 E 17TH ST, 309, SANTA ANA, CA 92705-8628
(714) 543-0425
(714) 543-2062
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
13905
CA
Other
Enumeration date
03/11/2014
Last updated
03/11/2014
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