Provider Demographics
NPI:1346524659
Name:BEN SHAMOIEL CHIROPRACTIC INC
Entity Type:Organization
Organization Name:BEN SHAMOIEL CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:604-760-1579
Mailing Address - Street 1:2080 CENTURY PARK EAST, SUITE 503
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067
Mailing Address - Country:US
Mailing Address - Phone:310-435-8899
Mailing Address - Fax:310-478-7605
Practice Address - Street 1:2080 CENTURY PARK EAST, SUITE 503
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067
Practice Address - Country:US
Practice Address - Phone:310-435-8899
Practice Address - Fax:310-478-7605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1234111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU12345Medicare UPIN