Provider Demographics
NPI:1326039207
Name:HENN, ILANIT (DC, BA, IME)
Entity Type:Individual
Prefix:DR
First Name:ILANIT
Middle Name:
Last Name:HENN
Suffix:
Gender:F
Credentials:DC, BA, IME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4924 BALBOA BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3402
Mailing Address - Country:US
Mailing Address - Phone:818-385-0385
Mailing Address - Fax:310-402-8167
Practice Address - Street 1:18719 CALVERT ST
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91335-6812
Practice Address - Country:US
Practice Address - Phone:818-385-0385
Practice Address - Fax:310-402-8167
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27791111NN1001X, 111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NS0005XChiropractic ProvidersChiropractorSports Physician