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General NPI Number Information
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NPI Number | 1912560426
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Entity Type | Organization
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Legal Business Name | DR. TRACEY A BLEAHU CHIROPRACTIC INC
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Dates
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Enumeration Date | 04/19/2019
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Last Update Date | 08/09/2019
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Provider Practice Location Address
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Address Line | 20501 VENTURA BLVD STE 102
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-2393
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Country | US
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Telephone | 818-301-8762
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Fax | 818-301-8763
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Provider Business Mailing Address
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Address Line | 20501 VENTURA BLVD STE 102
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-2393
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Country | US
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Telephone | 818-301-8762
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Fax |
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Authorized Official
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Title or Position | DESIGNATED OFFICIAL
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Name | MARIA SOLITA ANGELES BERNARDINO
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Credential |
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Telephone | 818-301-8762
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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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