Healthcare Provider Details

I. General information

NPI: 1598923716
Provider Name (Legal Business Name): NAZARETH CLINIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 W OLYMPIC BLVD STE 321
LOS ANGELES CA
90006-2279
US

IV. Provider business mailing address

2140 W OLYMPIC BLVD STE 321
LOS ANGELES CA
90006-2279
US

V. Phone/Fax

Practice location:
  • Phone: 213-389-5865
  • Fax:
Mailing address:
  • Phone: 213-389-5865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC25845
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 6463
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC 25845
License Number StateCA

VIII. Authorized Official

Name: DR. LEE CHOU
Title or Position: CEO
Credential: DC
Phone: 213-389-5865