Healthcare Provider Details

I. General information

NPI: 1487174991
Provider Name (Legal Business Name): 360 SPORTS, SPINE AND WELLNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 06/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18800 DELAWARE ST STE 150
HUNTINGTON BEACH CA
92648-6012
US

IV. Provider business mailing address

18800 DELAWARE ST STE 150
HUNTINGTON BEACH CA
92648-6012
US

V. Phone/Fax

Practice location:
  • Phone: 714-848-9319
  • Fax:
Mailing address:
  • Phone: 714-848-9319
  • Fax: 714-847-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRIS MARKER
Title or Position: PHYSICIAN
Credential: DO
Phone: 714-848-9319