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General NPI Number Information
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NPI Number | 1699169417
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Entity Type | Individual
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Provider Name | MICHELLE ITSKOVICH DC
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Gender | Female
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Dates
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Enumeration Date | 03/19/2015
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Last Update Date | 01/06/2017
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Provider Practice Location Address
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Address Line | 11040 SANTA MONICA BLVD SUITE 450
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City | LOS ANGELES
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State | CA
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Zip | 90025-7515
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Country | US
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Telephone | 818-605-5472
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Fax | 424-230-3888
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Provider Business Mailing Address
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Address Line | 5419 NAGLE AVE
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City | SHERMAN OAKS
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State | CA
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Zip | 91401-5341
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Country | US
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Telephone | 818-605-5472
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 33224
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License Number State | CA
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