Provider Demographics
NPI:1285723999
Name:WEST, SAMUEL G (DC)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:G
Last Name:WEST
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15550 ROCKFIELD BLVD
Mailing Address - Street 2:B220
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2720
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:5479 E ABBEYFIELD ST
Practice Address - Street 2:2
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-3050
Practice Address - Country:US
Practice Address - Phone:562-498-6647
Practice Address - Fax:562-986-5677
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1497951834OtherGROUP NPI
CADC0169670OtherBLUE SHIELD
CAW22568OtherGROUP PTAN
CAWDC16967AOtherIND PTAN
CADC16967OtherCHIROPRACTIC LICENSE