Healthcare Provider Details

I. General information

NPI: 1629123559
Provider Name (Legal Business Name): PARK CENTER FOR HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22471 SUENO RD
WOODLAND HILLS CA
91364-2900
US

IV. Provider business mailing address

PO BOX 8188
CALABASAS CA
91372-8188
US

V. Phone/Fax

Practice location:
  • Phone: 818-222-5636
  • Fax: 818-222-8853
Mailing address:
  • Phone: 818-222-5636
  • Fax: 818-222-8853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberDC25493
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC14679
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC25493
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC5637
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC15677
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberDC14679
License Number StateCA

VIII. Authorized Official

Name: DR. JUDY F. LANE
Title or Position: OWNER
Credential: D.C.
Phone: 818-222-5636