Provider Demographics
NPI:1073745675
Name:AGOURA HILLS CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:AGOURA HILLS CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:DWAIN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-991-4900
Mailing Address - Street 1:30313 CANWOOD ST
Mailing Address - Street 2:#33
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4326
Mailing Address - Country:US
Mailing Address - Phone:818-991-4900
Mailing Address - Fax:818-991-4509
Practice Address - Street 1:30313 CANWOOD ST
Practice Address - Street 2:#33
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4326
Practice Address - Country:US
Practice Address - Phone:818-991-4900
Practice Address - Fax:818-991-4509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty