Provider Demographics
NPI:1477094282
Name:SPINE & JOINT CLINIC OF ORANGE COUNTY
Entity Type:Organization
Organization Name:SPINE & JOINT CLINIC OF ORANGE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:DELIBERATO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-385-3093
Mailing Address - Street 1:22706 ASPAN ST
Mailing Address - Street 2:SUITE #702
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1603
Mailing Address - Country:US
Mailing Address - Phone:949-385-3093
Mailing Address - Fax:
Practice Address - Street 1:22706 ASPAN ST
Practice Address - Street 2:SUITE #702
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1603
Practice Address - Country:US
Practice Address - Phone:949-385-3093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33796111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty