Healthcare Provider Details

I. General information

NPI: 1154551695
Provider Name (Legal Business Name): YOAV NAGAR CHIROPRACTIC PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12626 RIVERSIDE DR STE 301
NORTH HOLLYWOOD CA
91607-3473
US

IV. Provider business mailing address

12626 RIVERSIDE DR STE 301
NORTH HOLLYWOOD CA
91607-3473
US

V. Phone/Fax

Practice location:
  • Phone: 818-760-0110
  • Fax: 818-760-0137
Mailing address:
  • Phone: 818-760-0110
  • Fax: 818-760-0137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC-25477
License Number StateCA

VIII. Authorized Official

Name: DR. YOAV NAGAR
Title or Position: PRESIDENT
Credential: D.C.
Phone: 818-760-0110