Provider Demographics
NPI:1003011289
Name:KATLEIN PROFESSIONAL CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:KATLEIN PROFESSIONAL CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KATLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-985-5500
Mailing Address - Street 1:12080 VENTURA PL
Mailing Address - Street 2:STE B
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2632
Mailing Address - Country:US
Mailing Address - Phone:818-985-5500
Mailing Address - Fax:818-985-5502
Practice Address - Street 1:12080 VENTURA PL
Practice Address - Street 2:STE B
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2632
Practice Address - Country:US
Practice Address - Phone:818-985-5500
Practice Address - Fax:818-985-5502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28386111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC28386Medicare ID - Type Unspecified
CA6472990001Medicare NSC