Healthcare Provider Details

I. General information

NPI: 1770522773
Provider Name (Legal Business Name): TABER LUNG CHINN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23440 CIVIC CENTER WAY SUITE 204
MALIBU CA
90265-4854
US

IV. Provider business mailing address

23440 CIVIC CENTER WAY SUITE 204
MALIBU CA
90265-4854
US

V. Phone/Fax

Practice location:
  • Phone: 310-456-1972
  • Fax: 310-456-1974
Mailing address:
  • Phone: 310-456-1972
  • Fax: 310-456-1974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 26614
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: