Provider Demographics
NPI:1306506035
Name:TUSTIN FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:TUSTIN FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:323-728-3101
Mailing Address - Street 1:14591 NEWPORT AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6027
Mailing Address - Country:US
Mailing Address - Phone:714-368-7600
Mailing Address - Fax:
Practice Address - Street 1:14591 NEWPORT AVE STE 202
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6027
Practice Address - Country:US
Practice Address - Phone:714-368-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARINA L. HOLMES, DC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty