Provider Demographics
NPI:1023002581
Name:MORTENSEN, DAVID H (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:MORTENSEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3043 FOOTHILL BLVD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-2715
Mailing Address - Country:US
Mailing Address - Phone:818-957-4601
Mailing Address - Fax:
Practice Address - Street 1:3043 FOOTHILL BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-2715
Practice Address - Country:US
Practice Address - Phone:818-957-4601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2008-06-12
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
CADC12484111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic