Provider Demographics
NPI:1487009908
Name:SOUTH BAY TRAN CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:SOUTH BAY TRAN CHIROPRACTIC CORPORATION
Other - Org Name:DAO TRAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAO
Authorized Official - Middle Name:HOANG
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-263-7246
Mailing Address - Street 1:14921 PRAIRIE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1849
Mailing Address - Country:US
Mailing Address - Phone:310-263-7246
Mailing Address - Fax:310-263-7217
Practice Address - Street 1:14921 PRAIRIE AVE STE 2
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1849
Practice Address - Country:US
Practice Address - Phone:310-263-7246
Practice Address - Fax:310-263-7217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100097312001OtherBLUE SHIELD OF CALIFORNIA
CA1477633394OtherNPI