Provider Demographics
NPI:1467509190
Name:YORK, KEVIN Y (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:Y
Last Name:YORK
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 1:513 E MANCHESTER BLVD
Mailing Address - Street 2:201
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1907
Mailing Address - Country:US
Mailing Address - Phone:310-804-7732
Mailing Address - Fax:
Practice Address - Street 1:513 E MANCHESTER BLVD
Practice Address - Street 2:201
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1907
Practice Address - Country:US
Practice Address - Phone:310-804-7732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23469111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23469Medicare PIN