Provider Demographics
NPI:1124298054
Name:TRI COUNTY MEDICAL GROUP
Entity type:Organization
Organization Name:TRI COUNTY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-994-1131
Mailing Address - Street 1:1200 WILSHIRE BLVD STE 308
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1930
Mailing Address - Country:US
Mailing Address - Phone:714-994-1131
Mailing Address - Fax:714-994-0130
Practice Address - Street 1:1200 WILSHIRE BLVD STE 308
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1930
Practice Address - Country:US
Practice Address - Phone:714-994-1131
Practice Address - Fax:714-994-0130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty