Healthcare Provider Details

I. General information

NPI: 1316106248
Provider Name (Legal Business Name): O.C. SPINE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 12/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10130 GARDEN GROVE BLVD STE 105
GARDEN GROVE CA
92844-1690
US

IV. Provider business mailing address

10130 GARDEN GROVE BLVD STE 105
GARDEN GROVE CA
92844-1690
US

V. Phone/Fax

Practice location:
  • Phone: 714-530-8813
  • Fax: 714-530-8815
Mailing address:
  • Phone: 714-530-8813
  • Fax: 714-530-8815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC30336
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 11905
License Number StateCA

VIII. Authorized Official

Name: MR. JOSHUA CHO
Title or Position: SUPERVISOR
Credential: D.C.
Phone: 714-530-8813