Healthcare Provider Details

I. General information

NPI: 1174765317
Provider Name (Legal Business Name): DMITRIY SKLYUT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 04/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7067 HAWTHORN AVE SUITE 9
LOS ANGELES CA
90028-6910
US

IV. Provider business mailing address

7067 HAWTHORN AVE SUITE 9
LOS ANGELES CA
90028-6910
US

V. Phone/Fax

Practice location:
  • Phone: 323-791-4155
  • Fax:
Mailing address:
  • Phone: 323-791-4155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number30184
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: