Healthcare Provider Details

I. General information

NPI: 1649044157
Provider Name (Legal Business Name): GOLDMAN CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11620 WILSHIRE BLVD STE 710
LOS ANGELES CA
90025-1781
US

IV. Provider business mailing address

11620 WILSHIRE BLVD STE 710
LOS ANGELES CA
90025-1781
US

V. Phone/Fax

Practice location:
  • Phone: 310-426-8229
  • Fax:
Mailing address:
  • Phone: 310-426-8229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL JASON GOLDMAN
Title or Position: PRESIDENT, TREASURER
Credential: D.C.
Phone: 310-426-8229