Provider Demographics
NPI:1396738225
Name:KENNETH W LUTHER A CHIROPRACTI
Entity type:Organization
Organization Name:KENNETH W LUTHER A CHIROPRACTI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:EICHI
Authorized Official - Last Name:HIGASHI
Authorized Official - Suffix:
Authorized Official - Credentials:DC, ATC
Authorized Official - Phone:310-391-2617
Mailing Address - Street 1:3030 SAWTELLE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-1408
Mailing Address - Country:US
Mailing Address - Phone:310-391-2617
Mailing Address - Fax:310-390-0868
Practice Address - Street 1:3030 SAWTELLE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-1408
Practice Address - Country:US
Practice Address - Phone:310-391-2617
Practice Address - Fax:310-390-0868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27651111N00000X
CADC27775111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU86801Medicare UPIN