Healthcare Provider Details

I. General information

NPI: 1003342205
Provider Name (Legal Business Name): CAMARILLO CHIROPRACTIC & REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 BELLEVUE AVE
LOS ANGELES CA
90026-4017
US

IV. Provider business mailing address

5300 FAIRVIEW BLVD #15
LOS ANGELES CA
90056-2382
US

V. Phone/Fax

Practice location:
  • Phone: 213-413-2225
  • Fax: 213-413-2226
Mailing address:
  • Phone: 503-508-8570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 32760
License Number StateCA

VIII. Authorized Official

Name: LOUIS CAMARILLO
Title or Position: PRESIDENT
Credential: D.C.
Phone: 503-508-8570