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General NPI Number Information
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NPI Number | 1316106248
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Entity Type | Organization
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Legal Business Name | O.C. SPINE CENTER
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Dates
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Enumeration Date | 06/05/2008
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Last Update Date | 12/29/2008
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Provider Practice Location Address
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Address Line | 10130 GARDEN GROVE BLVD STE 105
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City | GARDEN GROVE
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State | CA
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Zip | 92844-1690
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Country | US
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Telephone | 714-530-8813
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Fax | 714-530-8815
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Provider Business Mailing Address
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Address Line | 10130 GARDEN GROVE BLVD STE 105
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City | GARDEN GROVE
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State | CA
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Zip | 92844-1690
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Country | US
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Telephone | 714-530-8813
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Fax | 714-530-8815
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Authorized Official
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Title or Position | SUPERVISOR
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Name | MR. JOSHUA CHO
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Credential | D.C.
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Telephone | 714-530-8813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC 11905
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC30336
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License Number State | CA
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