Provider Demographics
NPI:1225361595
Name:DR. KENGEE EHRLICH CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:DR. KENGEE EHRLICH CHIROPRACTIC INC.
Other - Org Name:THE GOOD CHIROPRACTOR
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:GEE
Authorized Official - Last Name:EHRLICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-479-1166
Mailing Address - Street 1:11945 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2706
Mailing Address - Country:US
Mailing Address - Phone:310-479-1166
Mailing Address - Fax:310-496-0229
Practice Address - Street 1:11945 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2706
Practice Address - Country:US
Practice Address - Phone:310-479-1166
Practice Address - Fax:310-496-0229
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE GOOD CHIROPRACTOR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-17
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEH104AMedicare UPIN