Provider Demographics
NPI:1619197035
Name:MARY PHAM CHIROPRACTIC INC
Entity Type:Organization
Organization Name:MARY PHAM CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-654-8219
Mailing Address - Street 1:14795 JEFFRY ROAD # 104
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618
Mailing Address - Country:US
Mailing Address - Phone:949-654-8219
Mailing Address - Fax:
Practice Address - Street 1:14795 JEFFRY ROAD # 104
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618
Practice Address - Country:US
Practice Address - Phone:949-654-8219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22812111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1619197035OtherBLUE CROSS / BLUE SHIELD OF ILLINOIS
CA1619197035OtherPACIFICARE
CA1619197035OtherUNITED HEALTHCARE
CA1619197035OtherANTHEM BLUE CROSS
CA1619197035OtherBLUE CROSS OF CALIFORNIA
CA1619197035OtherOHI INC. (OXFORD HEALTH PLANS)
CA1619197035OtherBLUE CROSS / BLUE SHIELD OF GEORGIA
CA1619197035OtherCIGNA
CA1619197035OtherBLUE SHIELD OF CALIFORNIA
CA1619197035OtherAETNA
CA1619197035OtherBLUE SHIELD OF PENNSYLVANIA
CA1619197035OtherBLUE SHIELD OF ILLINOIS
CA1619197035OtherREGENCE BLUE SHIELD
CA1619197035OtherBLUE CROSS / BLUE SHIELD OF TEXAS
CA1619197035OtherBLUE SHIELD OF TEXAS
CA1619197035OtherGREAT WEST