Provider Demographics
NPI:1417924259
Name:GOLDSTEIN, ANITA (DC)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 ROBERTS AVE
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-7414
Mailing Address - Country:US
Mailing Address - Phone:310-567-7977
Mailing Address - Fax:
Practice Address - Street 1:3121 ROBERTS AVE
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-7414
Practice Address - Country:US
Practice Address - Phone:310-567-7977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29526111NN1001X
CA29526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
V04008Medicare UPIN
W16163Medicare ID - Type Unspecified