MEDICARE: PAVEL GRYUNSHPAN 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	111NI0900X	Internist Chiropractor	DC29542	CA

General Provider Information

NPI Number	:	1225120587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAVEL GRYUNSHPAN CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	425 S FAIRFAX AVE # 201
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-3148
Country	:	US
Telephone Number	:	323-936-0149
Fax Number	:	323-936-0173

Provider Business Practice Location Address
First Line	:	425 S FAIRFAX AVE # 201
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-3148
Country	:	US
Telephone Number	:	323-936-0149
Fax Number	:	323-936-0173

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PAVEL GRYUNSHPAN
Credential	:	D.C.
Telephone Number	:	323-936-0149

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	08/22/2020

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