Healthcare Provider Details

I. General information

NPI: 1952576811
Provider Name (Legal Business Name): ACU-CHIRO CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3755 BEVERLY BLVD 3RD FLOOR
LOS ANGELES CA
90004-3539
US

IV. Provider business mailing address

3755 BEVERLY BLVD 3RD FLOOR
LOS ANGELES CA
90004-3539
US

V. Phone/Fax

Practice location:
  • Phone: 323-667-2400
  • Fax: 323-667-2411
Mailing address:
  • Phone: 323-667-2400
  • Fax: 323-667-2411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC29495
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC7286
License Number StateCA

VIII. Authorized Official

Name: NELSON HAE LEE
Title or Position: PRESIDENT
Credential: D.C., L.AC
Phone: 323-667-2400