Provider Demographics
NPI:1902413107
Name:MINA ROSHANKAR INC
Entity Type:Organization
Organization Name:MINA ROSHANKAR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSHANKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-756-1003
Mailing Address - Street 1:1076 E 1ST ST STE A
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3852
Mailing Address - Country:US
Mailing Address - Phone:949-756-1003
Mailing Address - Fax:888-290-1158
Practice Address - Street 1:1076 E 1ST ST STE A
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3852
Practice Address - Country:US
Practice Address - Phone:949-756-1003
Practice Address - Fax:888-290-1158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty