Provider Demographics
NPI:1730468497
Name:ANAHEIM INJURY CENTER
Entity Type:Organization
Organization Name:ANAHEIM INJURY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-828-9235
Mailing Address - Street 1:2500 W LINCOLN AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-6421
Mailing Address - Country:US
Mailing Address - Phone:714-828-9235
Mailing Address - Fax:714-828-9592
Practice Address - Street 1:2500 W LINCOLN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-6421
Practice Address - Country:US
Practice Address - Phone:714-828-9235
Practice Address - Fax:714-828-9592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28186111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty