Provider Demographics
NPI:1356717284
Name:UNISON SPINE CENTER
Entity type:Organization
Organization Name:UNISON SPINE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HSU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-296-1189
Mailing Address - Street 1:4173 DE MILLE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-3102
Mailing Address - Country:US
Mailing Address - Phone:408-296-1189
Mailing Address - Fax:
Practice Address - Street 1:550 LAKESIDE DR
Practice Address - Street 2:SUITE 5
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-4090
Practice Address - Country:US
Practice Address - Phone:408-296-1189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-14
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171100000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty