MEDICARE: JOEL E. BIENENFELD 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
1	111NS0005X	Sports Physician Chiropractor	DC15136	CA
2	111NX0800X	Orthopedic Chiropractor	DC15136	CA

General Provider Information

NPI Number	:	1710903927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL E. BIENENFELD D.C.

Provider Business Mailing Address
First Line	:	2417 CASTLE HEIGHTS AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-1051
Country	:	US
Telephone Number	:	310-993-6656
Fax Number	:	818-348-1129

Provider Business Practice Location Address
First Line	:	2417 CASTLE HEIGHTS AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-1051
Country	:	US
Telephone Number	:	310-993-6656
Fax Number	:	818-348-1129

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	05/09/2014

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