1518229863 NPI number — OC NECK & BACK THERAPY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518229863 NPI number — OC NECK & BACK THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OC NECK & BACK THERAPY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518229863
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20151 SW BIRCH ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
NEWPORT BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92660-1793
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-851-5900
Provider Business Mailing Address Fax Number:
949-851-5901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20151 SW BIRCH ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
NEWPORT BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92660-1793
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-851-5900
Provider Business Practice Location Address Fax Number:
949-851-5901
Provider Enumeration Date:
06/12/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
POLNY
Authorized Official First Name:
BOHDAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
949-851-5900

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)