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General NPI Number Information
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NPI Number | 1639404023
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Entity Type | Organization
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Legal Business Name | GATEWAY CHIROPRACTIC GROUP
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Dates
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Enumeration Date | 10/02/2009
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Last Update Date | 10/02/2009
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Provider Practice Location Address
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Address Line | 2677 ZOE AVE SUITE 305
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-4195
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Country | US
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Telephone | 323-583-0014
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Fax | 323-583-8843
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Provider Business Mailing Address
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Address Line | 2677 ZOE AVE SUITE 305
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-4195
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Country | US
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Telephone | 323-583-0014
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Fax | 323-583-8843
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Authorized Official
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Title or Position | PARTNER
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Name | HOMAYOUN DAVID HAMIDI
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Credential | D.C.
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Telephone | 714-863-6196
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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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