Healthcare Provider Details

I. General information

NPI: 1427718170
Provider Name (Legal Business Name): DAN TIAN HOLISTIC CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 CORPORATE PARK STE 205
IRVINE CA
92606-5180
US

IV. Provider business mailing address

4521 CAMPUS DR STE 386
IRVINE CA
92612-2621
US

V. Phone/Fax

Practice location:
  • Phone: 949-382-1652
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE L
Title or Position: BILLER
Credential:
Phone: 949-382-1652