=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811281884
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WHITTIER SPINE CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2011
-----------------------------------------------------
Last Update Date | 03/09/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16214 WHITTIER BLVD
-----------------------------------------------------
City | WHITTIER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90603-2901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-902-9292
-----------------------------------------------------
Fax | 562-315-5266
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16214 WHITTIER BLVD
-----------------------------------------------------
City | WHITTIER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90603-2901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-902-9292
-----------------------------------------------------
Fax | 562-315-5266
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BRUCE A WEILAND
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 562-902-9292
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A51161
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2081N0008X
-----------------------------------------------------
Taxonomy Name | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | G072815
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------