Provider Demographics
NPI:1023892254
Name:BALUCANAG, TYRONE (DC)
Entity type:Individual
Prefix:DR
First Name:TYRONE
Middle Name:
Last Name:BALUCANAG
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14405 SPECTRUM
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3409
Mailing Address - Country:US
Mailing Address - Phone:951-858-0500
Mailing Address - Fax:
Practice Address - Street 1:1350 REYNOLDS AVE STE 105
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-5526
Practice Address - Country:US
Practice Address - Phone:951-858-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36713111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor