Provider Demographics
NPI:1396814323
Name:VESELY, MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:VESELY
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 1:2940 WESTWOOD BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-4145
Mailing Address - Country:US
Mailing Address - Phone:310-446-6699
Mailing Address - Fax:310-446-6253
Practice Address - Street 1:2940 WESTWOOD BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-4145
Practice Address - Country:US
Practice Address - Phone:310-446-6699
Practice Address - Fax:310-446-6253
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18992111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU00969Medicare UPIN