Provider Demographics
NPI:1306904586
Name:HOLISTIC DOCTOR GROUP
Entity type:Organization
Organization Name:HOLISTIC DOCTOR GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:DAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DC OMD LAC CPT FIACA
Authorized Official - Phone:310-378-9990
Mailing Address - Street 1:22930 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505
Mailing Address - Country:US
Mailing Address - Phone:310-378-9990
Mailing Address - Fax:310-378-1170
Practice Address - Street 1:22930 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-378-9990
Practice Address - Fax:310-378-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 10708111N00000X, 111NR0200X, 111NR0400X
CAAC2645171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Multi-Specialty
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty