Healthcare Provider Details

I. General information

NPI: 1649500547
Provider Name (Legal Business Name): MARY TRUMPI CHIROPRACTIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2009
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WILSHIRE BLVD STE 410
SANTA MONICA CA
90401-1886
US

IV. Provider business mailing address

900 WILSHIRE BLVD STE 410
SANTA MONICA CA
90401-1886
US

V. Phone/Fax

Practice location:
  • Phone: 310-458-1259
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number27959
License Number StateCA

VIII. Authorized Official

Name: DR. MARY TRUMPI
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 310-458-1259