Provider Demographics
NPI:1033303565
Name:ROTHMAN CHIROPRACTIC CORP
Entity Type:Organization
Organization Name:ROTHMAN CHIROPRACTIC CORP
Other - Org Name:VITALITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YARIV
Authorized Official - Middle Name:EMANUEL
Authorized Official - Last Name:ROTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-396-3635
Mailing Address - Street 1:318 LINCOLN BLVD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-2827
Mailing Address - Country:US
Mailing Address - Phone:310-396-3635
Mailing Address - Fax:
Practice Address - Street 1:318 LINCOLN BLVD
Practice Address - Street 2:SUITE 225
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-2827
Practice Address - Country:US
Practice Address - Phone:310-396-3635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty