Provider Demographics
NPI:1609342567
Name:MAA, CHRIS (LAC, ATC, DACM)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:
Last Name:MAA
Suffix:
Gender:M
Credentials:LAC, ATC, DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3151 AIRWAY AVE
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4607
Mailing Address - Country:US
Mailing Address - Phone:714-540-1710
Mailing Address - Fax:714-540-3191
Practice Address - Street 1:3151 AIRWAY AVE
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4607
Practice Address - Country:US
Practice Address - Phone:714-540-1710
Practice Address - Fax:714-540-3191
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000124642255A2300X
CA17984171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer