Provider Demographics
NPI:1982320388
Name:SUSAN HA WELLNESS AND CHIROPRACTIC CORP
Entity Type:Organization
Organization Name:SUSAN HA WELLNESS AND CHIROPRACTIC CORP
Other - Org Name:ANEW WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACUPUNCTURIST/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HA
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LAC
Authorized Official - Phone:714-263-5005
Mailing Address - Street 1:4060 CAMPUS DR STE 130
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2205
Mailing Address - Country:US
Mailing Address - Phone:714-263-5005
Mailing Address - Fax:
Practice Address - Street 1:4060 CAMPUS DR STE 130
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2205
Practice Address - Country:US
Practice Address - Phone:714-263-5005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-17
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty