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NPI Code Detail

MEDICARE: MRS. MICHELE DOREEN CLEVELAND-BOSTEN D.C.

MEDICARE: MRS. MICHELE DOREEN CLEVELAND-BOSTEN D.C.
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
1111N00000XChiropractorDC17611CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
117611AOTHERCAWDC

General Provider Information

NPI Number : 1669589883
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHELE DOREEN CLEVELAND-BOSTEN D.C.
Provider Business Mailing Address
First Line : 3283 MOTOR AVENUE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90034
Country : US
Telephone Number : 310-559-6900
Fax Number : 310-836-8664
Provider Business Practice Location Address
First Line : 3283 MOTOR AVENUE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90034
Country : US
Telephone Number : 310-559-6900
Fax Number : 310-836-8664
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2006
Last Update Date : 01/05/2015

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