Healthcare Provider Details

I. General information

NPI: 1538285531
Provider Name (Legal Business Name): DANA CHURCHILL ND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DANA CHURCHILL ND

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11704 WILSHIRE BLVD D202
LOS ANGELES CA
90025-1507
US

IV. Provider business mailing address

11704 WILSHIRE BLVD D202
LOS ANGELES CA
90025-1507
US

V. Phone/Fax

Practice location:
  • Phone: 310-230-5228
  • Fax: 310-526-7501
Mailing address:
  • Phone: 310-230-5228
  • Fax: 310-526-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND173
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: