Stacey Gillis Chiropractic Inc

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC28079 Issued in CA

Legal business name

STACEY GILLIS CHIROPRACTIC INC

Doing business as

Harbor Family Chiropractic

Practice address

2200 Harbor Blvd
Suite B-160
Costa Mesa, CA 92627-2501

Phone

(949) 515-5170

Fax

(949) 515-5173

NPI assigned

Jul 12, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stacey Gillis, D.C.

Title

President

Phone

(949) 515-5170

Specialties & licenses 1

Addresses

Other names 1

• Harbor Family Chiropractic Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1278892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278892800000",
    "number": "1477865087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 HARBOR BLVD",
            "address_2": "SUITE B-160",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926272501",
            "telephone_number": "949-515-5170",
            "fax_number": "949-515-5173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 HARBOR BLVD",
            "address_2": "SUITE B-160",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926272501",
            "telephone_number": "949-515-5170",
            "fax_number": "949-515-5173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STACEY GILLIS CHIROPRACTIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-12",
        "last_updated": "2010-07-12",
        "status": "A",
        "authorized_official_last_name": "GILLIS",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-515-5170",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC28079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harbor Family Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Chiropractor in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.