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General NPI Number Information
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NPI Number | 1316225345
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Entity Type | Organization
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Legal Business Name | PARAGON CHIROPRACTIC, PAVAN INC.
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Dates
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Enumeration Date | 07/25/2011
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Last Update Date | 07/25/2011
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Provider Practice Location Address
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Address Line | 1821 WILSHIRE BLVD SUITE 500
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City | SANTA MONICA
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State | CA
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Zip | 90403-5618
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Country | US
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Telephone | 310-453-4700
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Fax | 310-453-1801
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Provider Business Mailing Address
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Address Line | 1821 WILSHIRE BLVD SUITE 500
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City | SANTA MONICA
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State | CA
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Zip | 90403-5618
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Country | US
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Telephone | 310-453-4700
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Fax | 310-453-1801
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | MICHAEL PAVAN
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Credential | D.C.
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Telephone | 310-453-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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