Provider Demographics
NPI:1336460781
Name:COFFEY, GENE PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:PATRICK
Last Name:COFFEY
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 1:210 NORTH AVE 64
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-2731
Mailing Address - Country:US
Mailing Address - Phone:323-254-2882
Mailing Address - Fax:323-254-3808
Practice Address - Street 1:210 NORTH AVE 64
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-2731
Practice Address - Country:US
Practice Address - Phone:323-254-2882
Practice Address - Fax:323-254-3808
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27321111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor