Healthcare Provider Details

I. General information

NPI: 1932432465
Provider Name (Legal Business Name): ANDALISIA THERAPY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8157 SANTA MONICA BLVD
WEST HOLLYWOOD CA
90046-4912
US

IV. Provider business mailing address

8157 SANTA MONICA BLVD
WEST HOLLYWOOD CA
90046-4912
US

V. Phone/Fax

Practice location:
  • Phone: 323-848-8036
  • Fax: 323-848-8294
Mailing address:
  • Phone: 323-848-8036
  • Fax: 323-848-8294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License NumberDC29483
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC29483
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC11638
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC29483
License Number StateCA

VIII. Authorized Official

Name: SHERA ALLEN
Title or Position: CLINIC DIRECTOR
Credential:
Phone: 323-848-8282