Provider Demographics
NPI:1053675041
Name:BUSINESS INDUSTRIAL CHIROPRACTIC SERVICES 2020, LLC
Entity Type:Organization
Organization Name:BUSINESS INDUSTRIAL CHIROPRACTIC SERVICES 2020, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-469-3262
Mailing Address - Street 1:7733 HENEFER AVE
Mailing Address - Street 2:STE A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-1140
Mailing Address - Country:US
Mailing Address - Phone:310-910-0238
Mailing Address - Fax:
Practice Address - Street 1:8632 S SEPULVEDA BLVD
Practice Address - Street 2:STE 101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-4015
Practice Address - Country:US
Practice Address - Phone:310-914-0023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15402111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty