=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881768588
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANIBAL SALAS ORTIZ D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2006
-----------------------------------------------------
Last Update Date | 07/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11340 W OLYMPIC BLVD SUITE 165
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90064-1608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-914-9400
-----------------------------------------------------
Fax | 310-914-9411
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14005 CHADRON AVE APARTMENT 10
-----------------------------------------------------
City | HAWTHORNE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90250-8801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-634-8143
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC29985
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------