Provider Demographics
NPI:1841405453
Name:T HO CHIROPRACTIC CORP.
Entity Type:Organization
Organization Name:T HO CHIROPRACTIC CORP.
Other - Org Name:MISSION MEDICAL CHIROPRACTIC REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TZUEN JEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:626-285-9819
Mailing Address - Street 1:900 S SAN GABRIEL BLVD
Mailing Address - Street 2:#108
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-2762
Mailing Address - Country:US
Mailing Address - Phone:626-285-9819
Mailing Address - Fax:626-285-9838
Practice Address - Street 1:900 S SAN GABRIEL BLVD
Practice Address - Street 2:#108
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-2762
Practice Address - Country:US
Practice Address - Phone:626-285-9819
Practice Address - Fax:626-285-9838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13502OtherMEDICARE GROUP NUMBER
CAZZZ46803ZOtherBLUE SHIELD PROVIDER NUM.
CAW13502OtherMEDICARE GROUP NUMBER
CAWDC21874AMedicare PIN
CAZZZ46803ZOtherBLUE SHIELD PROVIDER NUM.