Healthcare Provider Details

I. General information

NPI: 1316079841
Provider Name (Legal Business Name): ERIC BADENER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1158 26TH ST 149
SANTA MONICA CA
90403-4621
US

IV. Provider business mailing address

1158 26TH ST 149
SANTA MONICA CA
90403-4621
US

V. Phone/Fax

Practice location:
  • Phone: 310-460-7353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC19698
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: