Healthcare Provider Details

I. General information

NPI: 1669896585
Provider Name (Legal Business Name): STEPHEN PRICE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

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

11457 PORTER VALLEY DR
NORTHRIDGE CA
91326-1707
US

V. Phone/Fax

Practice location:
  • Phone: 323-467-5200
  • Fax: 323-467-1952
Mailing address:
  • Phone: 818-425-1484
  • 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:
Title or Position:
Credential:
Phone: