Provider Demographics
NPI:1285705384
Name:LYNN KEREW CHIROPRACTIC , A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:LYNN KEREW CHIROPRACTIC , A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEREW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-399-0337
Mailing Address - Street 1:PO BOX 251736
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-9125
Mailing Address - Country:US
Mailing Address - Phone:310-399-0337
Mailing Address - Fax:310-399-3944
Practice Address - Street 1:3435 OCEAN PARK BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3301
Practice Address - Country:US
Practice Address - Phone:399-399-0337
Practice Address - Fax:310-399-3944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24153111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA24153Medicare ID - Type UnspecifiedMEDICARE
CAU60964Medicare UPIN