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General NPI Number Information
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NPI Number | 1013672385
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Entity Type | Individual
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Provider Name | MARIA-MAGDALENA NIKOLAEVA TCHERNOGOROVA DC
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Gender | Female
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Dates
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Enumeration Date | 11/02/2021
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | 8472 MELROSE PL
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-5308
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Country | US
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Telephone | 702-403-3607
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Fax |
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Provider Business Mailing Address
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Address Line | 13914 BORA BORA WAY APT 122
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6837
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Country | US
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Telephone | 702-403-3607
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC35082
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License Number State | CA
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