Provider Demographics
NPI:1801281035
Name:HEALTHY LIVING CHIROPRACTIC
Entity type:Organization
Organization Name:HEALTHY LIVING CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:NGOC-NGA
Authorized Official - Middle Name:THI
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:858-798-5235
Mailing Address - Street 1:11848 BERNARDO PLAZA CT
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2416
Mailing Address - Country:US
Mailing Address - Phone:858-798-5235
Mailing Address - Fax:858-798-5239
Practice Address - Street 1:11848 BERNARDO PLAZA CT
Practice Address - Street 2:SUITE 260
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2416
Practice Address - Country:US
Practice Address - Phone:858-798-5235
Practice Address - Fax:858-798-5239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 30931111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty