Provider Demographics
NPI:1083634505
Name:ROSEMEAD INJURY CENTER
Entity Type:Organization
Organization Name:ROSEMEAD INJURY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAKE
Authorized Official - Middle Name:CHAN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:626-614-0055
Mailing Address - Street 1:9241 VALLEY BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1978
Mailing Address - Country:US
Mailing Address - Phone:626-614-0055
Mailing Address - Fax:626-614-0050
Practice Address - Street 1:9241 VALLEY BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1978
Practice Address - Country:US
Practice Address - Phone:626-614-0055
Practice Address - Fax:626-614-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26427111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U94805Medicare UPIN
CAV03077Medicare UPIN