Provider Demographics
NPI:1083822423
Name:ADVANCED CHIROPRACTIC & SPINAL REHAB.
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC & SPINAL REHAB.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GANGEMI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-450-8002
Mailing Address - Street 1:322 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-2632
Mailing Address - Country:US
Mailing Address - Phone:310-450-8002
Mailing Address - Fax:
Practice Address - Street 1:322 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-2632
Practice Address - Country:US
Practice Address - Phone:310-450-8002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27068111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty