Healthcare Provider Details

I. General information

NPI: 1457775355
Provider Name (Legal Business Name): TOTAL LOWBACK CARE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5336 FOUNTAIN AVE
LOS ANGELES CA
90029-1005
US

IV. Provider business mailing address

5336 FOUNTAIN AVE
LOS ANGELES CA
90029-1005
US

V. Phone/Fax

Practice location:
  • Phone: 323-467-5200
  • Fax: 323-467-1952
Mailing address:
  • Phone: 323-467-5200
  • Fax: 323-467-1952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberDC12023
License Number StateCA

VIII. Authorized Official

Name: DR. STEPHEN D PRICE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 323-467-5200