Healthcare Provider Details

I. General information

NPI: 1447479860
Provider Name (Legal Business Name): EDWARD HERMAN SCALE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 CENTER ST
EL SEGUNDO CA
90245-4206
US

IV. Provider business mailing address

2617 WALNUT AVE
MANHATTAN BEACH CA
90266-2733
US

V. Phone/Fax

Practice location:
  • Phone: 310-356-4843
  • Fax: 310-356-4847
Mailing address:
  • Phone: 310-545-9493
  • Fax: 310-356-4847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number111NS0005X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: