Provider Demographics
NPI:1720421316
Name:TUSTIN ELITE CHIROPRACTIC
Entity Type:Organization
Organization Name:TUSTIN ELITE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SALMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANAKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-202-2460
Mailing Address - Street 1:17291 IRVINE BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2941
Mailing Address - Country:US
Mailing Address - Phone:714-202-2460
Mailing Address - Fax:714-202-2795
Practice Address - Street 1:17291 IRVINE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2941
Practice Address - Country:US
Practice Address - Phone:714-202-2460
Practice Address - Fax:714-202-2795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-12
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32280111N00000X
CADC32196111N00000X
CAAC15326171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty