Provider Demographics
NPI:1992304380
Name:STAR CHIROPRACTIC AND REHABILITATION
Entity type:Organization
Organization Name:STAR CHIROPRACTIC AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:323-745-5427
Mailing Address - Street 1:562 N LARCHMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-1306
Mailing Address - Country:US
Mailing Address - Phone:323-745-5427
Mailing Address - Fax:
Practice Address - Street 1:562 N LARCHMONT BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-1306
Practice Address - Country:US
Practice Address - Phone:323-745-5427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STAR CHIROPRACTIC AND REHABILITATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-18
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy