Provider Demographics
NPI:1386996635
Name:HEALING TREE CLINIC
Entity type:Organization
Organization Name:HEALING TREE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:949-559-3675
Mailing Address - Street 1:14785 JEFFREY RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-0408
Mailing Address - Country:US
Mailing Address - Phone:949-559-3675
Mailing Address - Fax:949-559-3631
Practice Address - Street 1:14785 JEFFREY RD
Practice Address - Street 2:SUITE 109
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-0408
Practice Address - Country:US
Practice Address - Phone:949-559-3675
Practice Address - Fax:949-559-3631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31295111N00000X
CAAC9915171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty