Provider Demographics
NPI:1063659753
Name:WESTSIDE WELLNESS CENTER
Entity Type:Organization
Organization Name:WESTSIDE WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR CHIRO & CLINICAL SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:KELBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-231-7000
Mailing Address - Street 1:11645 WILSHIRE BLVD
Mailing Address - Street 2:120
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1708
Mailing Address - Country:US
Mailing Address - Phone:310-231-7000
Mailing Address - Fax:310-231-7000
Practice Address - Street 1:11645 WILSHIRE BLVD
Practice Address - Street 2:120
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1708
Practice Address - Country:US
Practice Address - Phone:310-231-7000
Practice Address - Fax:310-231-7000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16444111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty