Provider Demographics
NPI:1124241526
Name:GOHL & KIM CHIROPRACTIC, INC
Entity type:Organization
Organization Name:GOHL & KIM CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:808-944-1117
Mailing Address - Street 1:1111 N BRAND BLVD
Mailing Address - Street 2:# 402
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-3070
Mailing Address - Country:US
Mailing Address - Phone:818-243-6206
Mailing Address - Fax:818-243-2908
Practice Address - Street 1:1111 N BRAND BLVD
Practice Address - Street 2:# 402
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3070
Practice Address - Country:US
Practice Address - Phone:818-243-6206
Practice Address - Fax:818-243-2908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 26564111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty