Provider Demographics
NPI:1033570916
Name:GABRIEL Y. EDERY, D.C. CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:GABRIEL Y. EDERY, D.C. CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:EDERY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-651-3252
Mailing Address - Street 1:5354 LINDLEY AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-2914
Mailing Address - Country:US
Mailing Address - Phone:818-651-3252
Mailing Address - Fax:818-345-5529
Practice Address - Street 1:7439 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-2819
Practice Address - Country:US
Practice Address - Phone:818-345-4924
Practice Address - Fax:818-345-5529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32583111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty