Healthcare Provider Details

I. General information

NPI: 1245909100
Provider Name (Legal Business Name): DEFAZIO CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9478 W OLYMPIC BLVD
BEVERLY HILLS CA
90212-4246
US

IV. Provider business mailing address

PO BOX 1176
CARDIFF CA
92007-7176
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-1775
  • Fax:
Mailing address:
  • Phone: 585-097-9998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: PATRICK DEFAZIO
Title or Position: OWNER/CHIROPRACTOR
Credential:
Phone: 310-659-1775