Healthcare Provider Details

I. General information

NPI: 1780101832
Provider Name (Legal Business Name): BJ PARK, CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 08/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 WILSHIRE BLVD. SUITE 220
LOS ANGELES CA
90010
US

IV. Provider business mailing address

8540 RESEDA BLVD. SUITE 210
NORTHRIDGE CA
91324
US

V. Phone/Fax

Practice location:
  • Phone: 213-251-5860
  • Fax: 213-251-5861
Mailing address:
  • Phone: 818-701-7010
  • Fax: 818-701-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-28713
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC-17709
License Number StateCA

VIII. Authorized Official

Name: BUMJIN PARK
Title or Position: PRESIDENT
Credential: D.C.
Phone: 213-344-7197