Provider Demographics
NPI:1376768044
Name:A JUSPINE CHIROPACTIC INC
Entity Type:Organization
Organization Name:A JUSPINE CHIROPACTIC INC
Other - Org Name:REALIGN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAMJIN
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-949-5686
Mailing Address - Street 1:15923 BEAR VALLEY ROAD
Mailing Address - Street 2:#A210
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-1750
Mailing Address - Country:US
Mailing Address - Phone:760-949-5686
Mailing Address - Fax:760-949-5946
Practice Address - Street 1:15923 BEAR VALLEY ROAD
Practice Address - Street 2:#A210
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1750
Practice Address - Country:US
Practice Address - Phone:760-949-5686
Practice Address - Fax:760-949-5946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty