Provider Demographics
NPI:1205284494
Name:INLAND EMPIRE SPINE
Entity type:Organization
Organization Name:INLAND EMPIRE SPINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:909-829-8722
Mailing Address - Street 1:9673 SIERRA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-2424
Mailing Address - Country:US
Mailing Address - Phone:909-829-8722
Mailing Address - Fax:909-829-4403
Practice Address - Street 1:9673 SIERRA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-2424
Practice Address - Country:US
Practice Address - Phone:909-829-8722
Practice Address - Fax:909-829-4403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty