Provider Demographics
NPI:1316203052
Name:UPPER CERVICAL CHIROPRACTIC OF LOS ANGELES
Entity Type:Organization
Organization Name:UPPER CERVICAL CHIROPRACTIC OF LOS ANGELES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:323-887-4188
Mailing Address - Street 1:1125 W WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4640
Mailing Address - Country:US
Mailing Address - Phone:323-887-4188
Mailing Address - Fax:323-887-4188
Practice Address - Street 1:1125 W WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4640
Practice Address - Country:US
Practice Address - Phone:323-887-4188
Practice Address - Fax:323-887-4188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC3543305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service