Provider Demographics
NPI:1104076421
Name:OGINO, TERRY T (DC)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:T
Last Name:OGINO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 BAKER ST E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4509
Mailing Address - Country:US
Mailing Address - Phone:949-813-2196
Mailing Address - Fax:
Practice Address - Street 1:125 BAKER ST E
Practice Address - Street 2:SUITE 100
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4509
Practice Address - Country:US
Practice Address - Phone:949-813-2196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23343111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician