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General NPI Number Information
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NPI Number | 1245909100
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Entity Type | Organization
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Legal Business Name | DEFAZIO CHIROPRACTIC CORPORATION
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Dates
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Enumeration Date | 09/13/2021
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Last Update Date | 09/13/2021
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Provider Practice Location Address
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Address Line | 9478 W OLYMPIC BLVD
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-4246
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Country | US
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Telephone | 310-659-1775
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1176
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City | CARDIFF
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State | CA
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Zip | 92007-7176
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Country | US
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Telephone | 585-097-9998
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | PATRICK DEFAZIO
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Credential |
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Telephone | 310-659-1775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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