Provider Demographics
NPI:1942602255
Name:LIN, JONATHAN HSITARN (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:HSITARN
Last Name:LIN
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14785 JEFFREY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-0408
Mailing Address - Country:US
Mailing Address - Phone:949-857-2388
Mailing Address - Fax:
Practice Address - Street 1:14785 JEFFREY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-0408
Practice Address - Country:US
Practice Address - Phone:949-857-2388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33035111N00000X
CAAC16303171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist