Healthcare Provider Details

I. General information

NPI: 1447313614
Provider Name (Legal Business Name): ABC HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8730-E SANTA MONICA BLVD.
WEST HOLLYWOOD CA
90069
US

IV. Provider business mailing address

333 WASHINGTON BLVD. #419
MARINA DEL REY CA
90292
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-3200
  • Fax:
Mailing address:
  • Phone: 310-652-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC 24091
License Number StateCA

VIII. Authorized Official

Name: DR. ANDREA BRADSHAW
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 310-652-3200