Healthcare Provider Details

I. General information

NPI: 1396672424
Provider Name (Legal Business Name): DAVID WALKER BLACK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 WESTMINSTER AVE APT 4
VENICE CA
90291-5100
US

IV. Provider business mailing address

24 WESTMINSTER AVE APT 4
VENICE CA
90291-5100
US

V. Phone/Fax

Practice location:
  • Phone: 562-243-5595
  • Fax:
Mailing address:
  • Phone: 562-243-5595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC37559
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: