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General NPI Number Information
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NPI Number | 1265765408
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Entity Type | Organization
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Legal Business Name | DVORSKY CHIROPRACTIC INC
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Dates
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Enumeration Date | 09/04/2009
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Last Update Date | 09/04/2009
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Provider Practice Location Address
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Address Line | 2701 OCEAN PARK BLVD #118
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City | SANTA MONICA
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State | CA
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Zip | 90405-5200
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Country | US
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Telephone | 310-399-1885
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Fax | 310-399-1505
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Provider Business Mailing Address
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Address Line | 2701 OCEAN PARK BLVD #118
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City | SANTA MONICA
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State | CA
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Zip | 90405-5200
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Country | US
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Telephone | 310-399-1885
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Fax | 310-399-1505
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Authorized Official
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Title or Position | CEO
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Name | DR. JAY W DVORSKY
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Credential | D.C.
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Telephone | 310-399-1885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 19438
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License Number State | CA
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