Healthcare Provider Details

I. General information

NPI: 1104944024
Provider Name (Legal Business Name): PACIFIC SPINE & SPORTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14522 MYFORD RD
IRVINE CA
92606-1000
US

IV. Provider business mailing address

14522 MYFORD RD
IRVINE CA
92606-1000
US

V. Phone/Fax

Practice location:
  • Phone: 949-955-2655
  • Fax: 949-955-2699
Mailing address:
  • Phone: 949-955-2655
  • Fax: 949-955-2699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC23242
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC12049
License Number StateCA

VIII. Authorized Official

Name: DR. THAIKHANH A DINHLUU
Title or Position: OWNER
Credential: DC
Phone: 949-955-2655