Provider Demographics
NPI:1154864783
Name:BERNSTEIN ELITE SPORTS CHIROPRACTIC CORP.
Entity Type:Organization
Organization Name:BERNSTEIN ELITE SPORTS CHIROPRACTIC CORP.
Other - Org Name:ELITE SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-222-1120
Mailing Address - Street 1:22554 VENTURA BLVD
Mailing Address - Street 2:#130
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1413
Mailing Address - Country:US
Mailing Address - Phone:818-222-1120
Mailing Address - Fax:818-222-1138
Practice Address - Street 1:22554 VENTURA BLVD
Practice Address - Street 2:#130
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1413
Practice Address - Country:US
Practice Address - Phone:818-222-1120
Practice Address - Fax:818-222-1138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty