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General NPI Number Information
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NPI Number | 1427210822
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Entity Type | Organization
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Legal Business Name | WILSON C PARK CHIROPRACTIC CORP
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Dates
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Enumeration Date | 06/26/2008
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 2940 WESTWOOD BLVD #1
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City | LOS ANGELES
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State | CA
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Zip | 90064-4145
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Country | US
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Telephone | 310-869-0536
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Fax | 310-441-3727
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Provider Business Mailing Address
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Address Line | 2940 WESTWOOD BLVD #1
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City | LOS ANGELES
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State | CA
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Zip | 90064
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Country | US
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Telephone | 310-869-0536
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Fax | 310-441-3727
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | WILSON PARK
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Credential | DC
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Telephone | 310-869-0536
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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 | DC25166
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License Number State | CA
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