Provider Demographics
NPI:1124326988
Name:FROMER CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:FROMER CHIROPRACTIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:B
Authorized Official - Last Name:FROMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:323-962-8520
Mailing Address - Street 1:5123 W SUNSET BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5779
Mailing Address - Country:US
Mailing Address - Phone:323-962-8520
Mailing Address - Fax:323-962-6832
Practice Address - Street 1:5123 W SUNSET BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5779
Practice Address - Country:US
Practice Address - Phone:323-962-8520
Practice Address - Fax:323-962-6832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17684261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC17684OtherPTAN
CAT-18594Medicare UPIN