=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073602009
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENE ORLOWSKY, D.C. INC A CHIROPRACTIC CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2006
-----------------------------------------------------
Last Update Date | 01/12/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2646 MISSION ST
-----------------------------------------------------
City | SAN MARINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91108-1638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-441-2264
-----------------------------------------------------
Fax | 626-441-3533
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2646 MISSION ST
-----------------------------------------------------
City | SAN MARINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91108-1638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-441-2264
-----------------------------------------------------
Fax | 626-441-3533
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GENE ORLOWSKY
-----------------------------------------------------
Credential | CHIROPRACTOR
-----------------------------------------------------
Telephone | 626-441-2264
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC14181
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------