Provider Demographics
NPI:1417017849
Name:AUSTRIA, JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:AUSTRIA
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 1:10449 MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-4111
Mailing Address - Country:US
Mailing Address - Phone:818-980-5141
Mailing Address - Fax:818-980-9717
Practice Address - Street 1:10449 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-4111
Practice Address - Country:US
Practice Address - Phone:818-980-5141
Practice Address - Fax:818-980-9717
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-29162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU99154Medicare UPIN