Healthcare Provider Details

I. General information

NPI: 1407111750
Provider Name (Legal Business Name): DANTIAN THERAPY ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 AUTO CENTER DR #108
FOOTHILL RANCH CA
92610-2848
US

IV. Provider business mailing address

45 AUTO CENTER DR #108
FOOTHILL RANCH CA
92610-2848
US

V. Phone/Fax

Practice location:
  • Phone: 949-855-8948
  • Fax: 800-665-1218
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 28718
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 13611
License Number StateCA

VIII. Authorized Official

Name: DR. DANTIAN TING LIU
Title or Position: PRESIDENT
Credential:
Phone: 949-855-8948