Healthcare Provider Details

I. General information

NPI: 1275696619
Provider Name (Legal Business Name): TIMOTHY R TWOMBLY DC & KENNETH D ERICKSON DC A CHIROPRACTIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 ROOSEVELT SUITE# 100
IRVINE CA
92620-3686
US

IV. Provider business mailing address

15520 ROCKFIELD BLVD A220
IRVINE CA
92618-2717
US

V. Phone/Fax

Practice location:
  • Phone: 949-857-1888
  • Fax: 949-857-4536
Mailing address:
  • Phone: 949-598-9999
  • Fax: 949-598-9990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH DAVID ERICKSON
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 949-857-1888