Provider Demographics
NPI:1275242844
Name:ACOBA CHIROPRACTIC GROUP, APC
Entity Type:Organization
Organization Name:ACOBA CHIROPRACTIC GROUP, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOBA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:562-261-3333
Mailing Address - Street 1:902 N GRAND AVE STE 100A
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-4218
Mailing Address - Country:US
Mailing Address - Phone:657-600-9285
Mailing Address - Fax:657-600-9286
Practice Address - Street 1:902 N GRAND AVE STE 100A
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4218
Practice Address - Country:US
Practice Address - Phone:657-600-9285
Practice Address - Fax:657-600-9286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty