Healthcare Provider Details

I. General information

NPI: 1356265888
Provider Name (Legal Business Name): DR. LA FOUNTAIN VALLEY CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18430 BROOKHURST ST STE 103
FOUNTAIN VALLEY CA
92708-6726
US

IV. Provider business mailing address

9077 CARSON RIVER CIR
FOUNTAIN VALLEY CA
92708-6437
US

V. Phone/Fax

Practice location:
  • Phone: 714-316-0615
  • Fax:
Mailing address:
  • Phone: 408-205-9983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT THANH LA
Title or Position: OWNER/PRESIDENT
Credential: DC
Phone: 408-205-9983