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NPI Code Detail

MEDICARE: A FINE SPINE CHIROPRACTIC, A BOGOMOLNY CORP.

MEDICARE: A FINE SPINE CHIROPRACTIC, A BOGOMOLNY CORP.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor

General Provider Information

NPI Number : 1558922211
Entity Type Code : Organization
Provider Name (Legal Business Name) : A FINE SPINE CHIROPRACTIC, A BOGOMOLNY CORP.
Provider Business Mailing Address
First Line : 4624 MALEZA PL
Second Line :
City : TARZANA
State : CA
Zip : 91356-4721
Country : US
Telephone Number : 310-844-5502
Fax Number :
Provider Business Practice Location Address
First Line : 2812 SANTA MONICA BLVD STE 208
Second Line :
City : SANTA MONICA
State : CA
Zip : 90404-2432
Country : US
Telephone Number : 310-844-5502
Fax Number :
Authorized Official
Title or Position : OWNER
Name : RENEE FINE BOGOMOLNY
Credential : DC
Telephone Number : 310-844-5502
Provider Enumeration Date : 06/24/2019
Last Update Date : 08/01/2024

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