Provider Demographics
NPI:1730411331
Name:CHIROPRACTIC & OCCUPATIONAL HEALTH CENTER
Entity type:Organization
Organization Name:CHIROPRACTIC & OCCUPATIONAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:UYLIEM
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-782-0888
Mailing Address - Street 1:6411 SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 1N
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1304
Mailing Address - Country:US
Mailing Address - Phone:818-782-0888
Mailing Address - Fax:866-287-0714
Practice Address - Street 1:6411 SEPULVEDA BLVD
Practice Address - Street 2:SUITE 1N
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1304
Practice Address - Country:US
Practice Address - Phone:818-782-0888
Practice Address - Fax:866-287-0714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25910111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U73410Medicare UPIN