Provider Demographics
NPI:1801011713
Name:HEALTHY SPINE
Entity Type:Organization
Organization Name:HEALTHY SPINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MITZIE
Authorized Official - Middle Name:MIKA
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-901-4399
Mailing Address - Street 1:7040 TRASK AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-2622
Mailing Address - Country:US
Mailing Address - Phone:714-901-4399
Mailing Address - Fax:714-890-6012
Practice Address - Street 1:7040 TRASK AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-2622
Practice Address - Country:US
Practice Address - Phone:714-901-4399
Practice Address - Fax:714-890-6012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty