Healthcare Provider Details

I. General information

NPI: 1841480209
Provider Name (Legal Business Name): ANDREW MIN PARK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7065 INDIANA AVE STE 100&110
RIVERSIDE CA
92506-4167
US

IV. Provider business mailing address

7065 INDIANA AVE STE 100&110
RIVERSIDE CA
92506-4167
US

V. Phone/Fax

Practice location:
  • Phone: 951-476-0115
  • Fax: 951-479-0116
Mailing address:
  • Phone: 951-476-0115
  • Fax: 951-479-0116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC25781
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC17077
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: