Healthcare Provider Details

I. General information

NPI: 1871668426
Provider Name (Legal Business Name): MICHAEL TROY HURST DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5435 BALBOA BLVD SUITE 207
ENCINO CA
91316-1508
US

IV. Provider business mailing address

5435 BALBOA BLVD SUITE 207
ENCINO CA
91316-1576
US

V. Phone/Fax

Practice location:
  • Phone: 818-345-9100
  • Fax: 818-345-9104
Mailing address:
  • Phone: 818-345-9100
  • Fax: 818-345-9104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC27608
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: