Healthcare Provider Details

I. General information

NPI: 1962868935
Provider Name (Legal Business Name): MARTINEZ CHIROPRACTIC HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S BARRINGTON AVE SUITE 107
LOS ANGELES CA
90025-5363
US

IV. Provider business mailing address

2001 S BARRINGTON AVE SUITE 107
LOS ANGELES CA
90025-5363
US

V. Phone/Fax

Practice location:
  • Phone: 310-575-5535
  • Fax: 310-575-5536
Mailing address:
  • Phone: 310-575-5535
  • Fax: 310-575-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number33346
License Number StateCA

VIII. Authorized Official

Name: DUSTIN MARTINEZ
Title or Position: PRESIDENT
Credential: D.C.
Phone: 661-810-9031