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General NPI Number Information
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NPI Number | 1720500408
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Entity Type | Organization
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Legal Business Name | ORANGE COUNTY MISSION CHIROPRACTIC
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Dates
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Enumeration Date | 07/13/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 13422 NEWPORT AVE STE G
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City | TUSTIN
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State | CA
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Zip | 92780-3746
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Country | US
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Telephone | 714-731-7772
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Fax | 714-884-3644
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Provider Business Mailing Address
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Address Line | 13422 NEWPORT AVE STE G
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City | TUSTIN
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State | CA
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Zip | 92780-3746
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Country | US
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Telephone | 714-731-7772
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Fax | 714-884-3644
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Authorized Official
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Title or Position | OWNER
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Name | DR. GREG S KIM
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Credential | DC
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Telephone | 714-731-7772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 28104
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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 | 28104
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License Number State | CA
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