Healthcare Provider Details

I. General information

NPI: 1417173295
Provider Name (Legal Business Name): GLENFELIZ CHIROPRACTIC ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3171 LOS FELIZ BLVD SUITE 202
LOS ANGELES CA
90039-1527
US

IV. Provider business mailing address

3171 LOS FELIZ BLVD SUITE 202
LOS ANGELES CA
90039-1527
US

V. Phone/Fax

Practice location:
  • Phone: 323-662-2891
  • Fax:
Mailing address:
  • Phone: 323-662-2891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC23936
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberDC23936
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: MR. HAL JAY CLOSE
Title or Position: CFO
Credential:
Phone: 323-662-2891