Provider Demographics
NPI:1104944024
Name:PACIFIC SPINE & SPORTS, INC.
Entity type:Organization
Organization Name:PACIFIC SPINE & SPORTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THAIKHANH
Authorized Official - Middle Name:A
Authorized Official - Last Name:DINHLUU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-955-2655
Mailing Address - Street 1:14522 MYFORD RD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1000
Mailing Address - Country:US
Mailing Address - Phone:949-955-2655
Mailing Address - Fax:949-955-2699
Practice Address - Street 1:14522 MYFORD RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-1000
Practice Address - Country:US
Practice Address - Phone:949-955-2655
Practice Address - Fax:949-955-2699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12049171100000X
CADC23242111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty