Provider Demographics
NPI:1770243560
Name:SIDHU TRIUNE OF LIFE CHIROPRACTIC APC
Entity Type:Organization
Organization Name:SIDHU TRIUNE OF LIFE CHIROPRACTIC APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GURAVTAR
Authorized Official - Middle Name:S
Authorized Official - Last Name:SIDHU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-295-9000
Mailing Address - Street 1:15520 ROCKFIELD BLVD
Mailing Address - Street 2:STE A200
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-6705
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:410 S MELROSE DR
Practice Address - Street 2:STE 107
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6607
Practice Address - Country:US
Practice Address - Phone:760-295-9000
Practice Address - Fax:760-294-8499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-21
Last Update Date:2022-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty