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General NPI Number Information
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NPI Number | 1679713911
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC CARE CENTER INC.
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Dates
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Enumeration Date | 02/26/2009
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Last Update Date | 02/26/2009
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Provider Practice Location Address
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Address Line | 112 W 9TH ST SUITE 1126
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City | LOS ANGELES
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State | CA
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Zip | 90015-1510
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Country | US
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Telephone | 213-627-0287
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Fax | 213-627-8428
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Provider Business Mailing Address
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Address Line | 112 W 9TH ST SUITE 1126
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City | LOS ANGELES
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State | CA
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Zip | 90015-1510
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Country | US
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Telephone | 213-627-0287
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Fax | 213-627-8428
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD C PAN
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Credential | D.C.
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Telephone | 213-627-0287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | DC-30410
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License Number State | CA
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