Provider Demographics
NPI:1346686409
Name:DR TRAN HARBOR SPINE & WELLNESS CHIROPRACTIC INC
Entity Type:Organization
Organization Name:DR TRAN HARBOR SPINE & WELLNESS CHIROPRACTIC INC
Other - Org Name:HARBOR SPINE & WELLNESS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHANH
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-539-8250
Mailing Address - Street 1:12901 HARBOR BLVD.
Mailing Address - Street 2:SUITE A6
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840
Mailing Address - Country:US
Mailing Address - Phone:714-539-8250
Mailing Address - Fax:
Practice Address - Street 1:12901 HARBOR BLVD
Practice Address - Street 2:SUITE A6
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-5830
Practice Address - Country:US
Practice Address - Phone:714-539-8250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25631111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC25631Medicare PIN