Provider Demographics
NPI:1023462249
Name:TRUE SPORT USA, LLC
Entity type:Organization
Organization Name:TRUE SPORT USA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-415-6407
Mailing Address - Street 1:PO BOX 1176
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-7176
Mailing Address - Country:US
Mailing Address - Phone:858-509-7999
Mailing Address - Fax:
Practice Address - Street 1:4221 E CHANDLER BLVD
Practice Address - Street 2:#115
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-8874
Practice Address - Country:US
Practice Address - Phone:480-415-6407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDC111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty