Provider Demographics
NPI:1932828852
Name:LAM, TONY (DC)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:
Last Name:LAM
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 1:13101 ROBERTA PL
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-2143
Mailing Address - Country:US
Mailing Address - Phone:510-359-1615
Mailing Address - Fax:
Practice Address - Street 1:27462 PORTOLA PKWY STE 201
Practice Address - Street 2:
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610-2838
Practice Address - Country:US
Practice Address - Phone:510-359-1615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty