Provider Demographics
NPI:1699105544
Name:WESTERN UNITED MEDICAL CARE INC.
Entity type:Organization
Organization Name:WESTERN UNITED MEDICAL CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:MATIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:626-917-8706
Mailing Address - Street 1:1414 S AZUSA AVE STE B-6
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-4088
Mailing Address - Country:US
Mailing Address - Phone:626-917-8706
Mailing Address - Fax:
Practice Address - Street 1:1414 S AZUSA AVE STE B-5
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-4088
Practice Address - Country:US
Practice Address - Phone:626-917-8706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA448861111NI0900X
CADC23316111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23316Medicare PIN
CAA48861Medicare PIN