=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538501820
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ESUDRI CHIROPRACTIC APC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2013
-----------------------------------------------------
Last Update Date | 07/27/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6400 CANOGA AVE STE 333
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91367-2492
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-710-0800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6400 CANOGA AVE STE 333
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91367-2492
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-710-0800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DAVID ESUDRI
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 818-710-0800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC26546
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------