Provider Demographics
NPI:1275852543
Name:PLATON, ALEJANDRO BOLIVAR (DC, CCSP)
Entity type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:BOLIVAR
Last Name:PLATON
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1107
Mailing Address - Country:US
Mailing Address - Phone:213-384-8903
Mailing Address - Fax:213-384-7338
Practice Address - Street 1:2975 WILSHIRE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1107
Practice Address - Country:US
Practice Address - Phone:213-384-8903
Practice Address - Fax:213-384-7338
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21096111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor