Provider Demographics
NPI:1326073149
Name:ESUDRI, DAVID L (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:ESUDRI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 CANOGA AVE STE 333
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2492
Mailing Address - Country:US
Mailing Address - Phone:818-710-0800
Mailing Address - Fax:818-393-3168
Practice Address - Street 1:6400 CANOGA AVE STE 333
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2492
Practice Address - Country:US
Practice Address - Phone:818-710-0800
Practice Address - Fax:818-396-3168
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26546111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18041Medicare ID - Type UnspecifiedGROUP #
CAWDC26546AMedicare PIN