Provider Demographics
NPI:1285842583
Name:COMPREHENSIVE CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:COMPREHENSIVE CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:WALBURN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:323-721-7390
Mailing Address - Street 1:1817 W BEVERLY BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3935
Mailing Address - Country:US
Mailing Address - Phone:323-721-7390
Mailing Address - Fax:323-721-8513
Practice Address - Street 1:1817 W BEVERLY BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3935
Practice Address - Country:US
Practice Address - Phone:323-721-7390
Practice Address - Fax:323-721-8513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID