Provider Demographics
NPI:1316225345
Name:PARAGON CHIROPRACTIC, PAVAN INC.
Entity Type:Organization
Organization Name:PARAGON CHIROPRACTIC, PAVAN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-453-4700
Mailing Address - Street 1:1821 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5618
Mailing Address - Country:US
Mailing Address - Phone:310-453-4700
Mailing Address - Fax:310-453-1801
Practice Address - Street 1:1821 WILSHIRE BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5618
Practice Address - Country:US
Practice Address - Phone:310-453-4700
Practice Address - Fax:310-453-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty