Healthcare Provider Details

I. General information

NPI: 1578821229
Provider Name (Legal Business Name): ALTERNATIVE PAIN MANAGEMENT CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E COMPTON BLVD
COMPTON CA
90221-3209
US

IV. Provider business mailing address

500 E COMPTON BLVD
COMPTON CA
90221-3209
US

V. Phone/Fax

Practice location:
  • Phone: 310-537-3467
  • Fax: 310-537-1966
Mailing address:
  • Phone: 310-537-3467
  • Fax: 310-537-1966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC16997
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. REUBEN A. BAKKAR
Title or Position: ADMINISTRATOR
Credential: D.C.
Phone: 310-537-3467