Provider Demographics
NPI:1770279010
Name:PAK, AARON MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:MICHAEL
Last Name:PAK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 N RICHMAN KNLS
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4049
Mailing Address - Country:US
Mailing Address - Phone:714-422-8950
Mailing Address - Fax:
Practice Address - Street 1:817 W 9TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3603
Practice Address - Country:US
Practice Address - Phone:714-422-8950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36647111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor