Provider Demographics
NPI:1285853879
Name:KENNETH W. LUTHER CHIROPRACTIC CORP.
Entity Type:Organization
Organization Name:KENNETH W. LUTHER CHIROPRACTIC CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:VALARI
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:CAPOZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-391-2617
Mailing Address - Street 1:3030 SAWTELLE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-1408
Mailing Address - Country:US
Mailing Address - Phone:310-391-2617
Mailing Address - Fax:310-390-0868
Practice Address - Street 1:3030 SAWTELLE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-1408
Practice Address - Country:US
Practice Address - Phone:310-391-2617
Practice Address - Fax:310-390-0868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19312Medicare ID - Type Unspecified