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General NPI Number Information
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NPI Number | 1629587555
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Entity Type | Organization
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Legal Business Name | BASS CHIROPRACTIC PROFESSIONAL CORP
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Dates
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Enumeration Date | 09/22/2017
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Last Update Date | 01/18/2021
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Provider Practice Location Address
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Address Line | 8455 BEVERLY BLVD STE 505
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City | LOS ANGELES
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State | CA
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Zip | 90048-3445
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Country | US
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Telephone | 323-944-0773
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1176
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City | CARDIFF
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State | CA
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Zip | 92007-7176
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Country | US
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Telephone | 858-509-7999
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | MARISSA NICOLE BASS
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Credential | D.C.
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Telephone | 323-944-0773
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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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