=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053640409
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL JEREMY MAXWELL LEVIN D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2009
-----------------------------------------------------
Last Update Date | 12/14/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2016 HILLHURST AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90027-2703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-913-1930
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1954 HILLHURST AVE SUITE 213
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90027-2722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-913-1930
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC28512
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------