Healthcare Provider Details

I. General information

NPI: 1609038603
Provider Name (Legal Business Name): FIELDER CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 OCEAN PARK BLVD
SANTA MONICA CA
90405
US

IV. Provider business mailing address

2817 OCEAN PARK BLVD
SANTA MONICA CA
90405
US

V. Phone/Fax

Practice location:
  • Phone: 310-450-5848
  • Fax:
Mailing address:
  • Phone: 310-450-5848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC16115
License Number StateCA

VIII. Authorized Official

Name: ARTHUR FIELDER
Title or Position: OWNER
Credential:
Phone: 310-450-5848