Healthcare Provider Details

I. General information

NPI: 1821209008
Provider Name (Legal Business Name): DWAYNE ACOBA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 LONG BEACH BLVD
LONG BEACH CA
90807-2617
US

IV. Provider business mailing address

4430 E 14TH ST
LONG BEACH CA
90804-3103
US

V. Phone/Fax

Practice location:
  • Phone: 562-261-3333
  • Fax: 866-323-6162
Mailing address:
  • Phone: 562-261-3333
  • Fax: 866-323-6162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-26833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: