Provider Demographics
NPI:1619167327
Name:DIO KIM CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:DIO KIM CHIROPRACTIC CORPORATION
Other - Org Name:DIO KIM CHIROPRACTIC & ACUPUNCTURE CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIO
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LAC
Authorized Official - Phone:714-505-1514
Mailing Address - Street 1:513 E 1ST ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3348
Mailing Address - Country:US
Mailing Address - Phone:714-505-1514
Mailing Address - Fax:714-505-1513
Practice Address - Street 1:513 E 1ST ST
Practice Address - Street 2:SUITE A
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3348
Practice Address - Country:US
Practice Address - Phone:714-505-1514
Practice Address - Fax:714-505-1513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27994111N00000X
CAAC10600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty