Provider Demographics
NPI:1639368566
Name:TRAN PROFESSIONAL CHIROPRACTIC CORP.
Entity Type:Organization
Organization Name:TRAN PROFESSIONAL CHIROPRACTIC CORP.
Other - Org Name:TRINITY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HIEN
Authorized Official - Middle Name:LUU
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-255-8880
Mailing Address - Street 1:5114 EL CAJON BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-4723
Mailing Address - Country:US
Mailing Address - Phone:619-255-8880
Mailing Address - Fax:619-286-0418
Practice Address - Street 1:5114 EL CAJON BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-4723
Practice Address - Country:US
Practice Address - Phone:619-255-8880
Practice Address - Fax:619-286-0418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGDC000510Medicaid