Provider Demographics
NPI:1619016490
Name:BLACK, HAROLD STEVE (DC)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:STEVE
Last Name:BLACK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10729
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92711-0729
Mailing Address - Country:US
Mailing Address - Phone:714-835-1111
Mailing Address - Fax:714-835-0244
Practice Address - Street 1:630 S GRAND AVE
Practice Address - Street 2:SUITE #105
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4164
Practice Address - Country:US
Practice Address - Phone:714-835-1111
Practice Address - Fax:714-835-0244
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0234980Medicare ID - Type Unspecified
CAU55040Medicare UPIN