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General NPI Number Information
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NPI Number | 1427415033
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Entity Type | Organization
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Legal Business Name | COLLAZO CHIROPRACTIC
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Dates
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Enumeration Date | 01/27/2016
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Last Update Date | 01/27/2016
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Provider Practice Location Address
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Address Line | 400 N FORD BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90022-1122
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Country | US
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Telephone | 323-262-9222
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Fax | 323-262-9261
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Provider Business Mailing Address
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Address Line | 400 N FORD BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90022-1122
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Country | US
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Telephone | 323-262-9222
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Fax | 323-262-9261
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Authorized Official
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Title or Position | OWNER
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Name | JEAN S COLLAZO
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Credential | DC
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Telephone | 323-262-9222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | DC26035
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License Number State | CA
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