Healthcare Provider Details

I. General information

NPI: 1699134536
Provider Name (Legal Business Name): HIWOT ASSEFA MELKA D.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2016
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16200 AMBER VALLEY DR PRIMARY SPINE CARE RESIDENT
WHITTIER CA
90604-4051
US

IV. Provider business mailing address

16200 AMBER VALLEY DR
WHITTIER CA
90604-4051
US

V. Phone/Fax

Practice location:
  • Phone: 562-943-7125
  • Fax:
Mailing address:
  • Phone: 562-943-7125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number33484
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6163
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: