Provider Demographics
NPI:1235279241
Name:THE LAUDIG CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:THE LAUDIG CHIROPRACTIC CENTER PC
Other - Org Name:TLC CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:LAUDIG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-530-1659
Mailing Address - Street 1:2170 LOMITA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-1623
Mailing Address - Country:US
Mailing Address - Phone:310-530-1659
Mailing Address - Fax:310-530-1663
Practice Address - Street 1:2170 LOMITA BLVD
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-1623
Practice Address - Country:US
Practice Address - Phone:310-530-1659
Practice Address - Fax:310-530-1663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28810111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2144935Medicaid
CAWDC28810AMedicare ID - Type Unspecified
CA2144935Medicaid