MEDICARE: DANA LARIDAEN D.C.

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	30839	CA

General Provider Information

NPI Number	:	1487824421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA LARIDAEN D.C.

Provider Business Mailing Address
First Line	:	2817 OCEAN PARK BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-2905
Country	:	US
Telephone Number	:	310-392-3929
Fax Number	:	310-392-3977

Provider Business Practice Location Address
First Line	:	2817 OCEAN PARK BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-2905
Country	:	US
Telephone Number	:	310-392-3929
Fax Number	:	310-392-3977

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2008
Last Update Date	:	09/10/2014

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Directions to “ DANA LARIDAEN D.C.” Practice Location

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