=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033570916
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GABRIEL Y. EDERY, D.C. CHIROPRACTIC, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2016
-----------------------------------------------------
Last Update Date | 10/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22311 VENTURA BLVD STE 116
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91364-1556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-651-3252
-----------------------------------------------------
Fax | 747-242-1300
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22311 VENTURA BLVD STE 116
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91364-1556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-651-3252
-----------------------------------------------------
Fax | 747-242-1300
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GABRIEL Y EDERY
-----------------------------------------------------
Credential | D.C
-----------------------------------------------------
Telephone | 818-651-3252
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC32583
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------