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General NPI Number Information
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NPI Number | 1598923716
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Entity Type | Organization
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Legal Business Name | NAZARETH CLINIC CORP
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Dates
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Enumeration Date | 05/23/2008
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Last Update Date | 05/23/2008
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Provider Practice Location Address
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Address Line | 2140 W OLYMPIC BLVD STE 321
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City | LOS ANGELES
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State | CA
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Zip | 90006-2279
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Country | US
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Telephone | 213-389-5865
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Fax |
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Provider Business Mailing Address
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Address Line | 2140 W OLYMPIC BLVD STE 321
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City | LOS ANGELES
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State | CA
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Zip | 90006-2279
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Country | US
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Telephone | 213-389-5865
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. LEE CHOU
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Credential | DC
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Telephone | 213-389-5865
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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 | DC25845
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC 6463
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | DC 25845
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License Number State | CA
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