MEDICARE: PTAK CHIROPRACTIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1134209240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PTAK CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	11545 WEST OLYMPIC BLVD
Second Line	:	SUITE B
City	:	LOS ANGELES
State	:	CA
Zip	:	90064
Country	:	US
Telephone Number	:	310-473-7991
Fax Number	:	310-473-7921

Provider Business Practice Location Address
First Line	:	11545 WEST OLYMPIC BLVD
Second Line	:	SUITE B
City	:	LOS ANGELES
State	:	CA
Zip	:	90064
Country	:	US
Telephone Number	:	310-473-7991
Fax Number	:	310-473-7921

Authorized Official
Title or Position	:	OFFICE ADMINISTRATOR CFO
Name	:	MS. PATRICIA MAE PTAK
Credential	:
Telephone Number	:	310-473-7991

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	01/18/2008

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Directions to “PTAK CHIROPRACTIC INC ” Practice Location

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