Healthcare Provider Details

I. General information

NPI: 1104154129
Provider Name (Legal Business Name): CULVER CITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2009
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4340 OVERLAND AVE
CULVER CITY CA
90230-4117
US

IV. Provider business mailing address

4340 OVERLAND AVE
CULVER CITY CA
90230-4117
US

V. Phone/Fax

Practice location:
  • Phone: 310-204-2555
  • Fax: 310-204-2522
Mailing address:
  • Phone: 310-204-2555
  • Fax: 310-204-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 27469
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC9487
License Number StateCA

VIII. Authorized Official

Name: DR. RENEE A. KOHANIM
Title or Position: PRESIDENT
Credential: D.C.
Phone: 310-204-2555