Provider Demographics
NPI:1104154129
Name:CULVER CITY HEALTH CENTER
Entity type:Organization
Organization Name:CULVER CITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOHANIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-204-2555
Mailing Address - Street 1:4340 OVERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4117
Mailing Address - Country:US
Mailing Address - Phone:310-204-2555
Mailing Address - Fax:310-204-2522
Practice Address - Street 1:4340 OVERLAND AVE
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4117
Practice Address - Country:US
Practice Address - Phone:310-204-2555
Practice Address - Fax:310-204-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9487171100000X
CADC 27469111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty