Healthcare Provider Details

I. General information

NPI: 1801993969
Provider Name (Legal Business Name): BENJAMIN WOLFE KLEINBRODT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11620 WILSHIRE BLVD STE 710
LOS ANGELES CA
90025-1781
US

IV. Provider business mailing address

11620 WILSHIRE BLVD STE 710
LOS ANGELES CA
90025-1781
US

V. Phone/Fax

Practice location:
  • Phone: 310-826-0721
  • Fax:
Mailing address:
  • Phone: 310-826-0721
  • Fax: 310-826-9894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC27789
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: