Provider Demographics
NPI:1487687463
Name:PREMIERE CHIROPRACTIC AND SPORTS MEDICINE
Entity Type:Organization
Organization Name:PREMIERE CHIROPRACTIC AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-798-8777
Mailing Address - Street 1:403 N PACIFIC COAST HWY
Mailing Address - Street 2:201
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2839
Mailing Address - Country:US
Mailing Address - Phone:310-798-8777
Mailing Address - Fax:310-798-8783
Practice Address - Street 1:403 N PACIFIC COAST HWY
Practice Address - Street 2:201
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2839
Practice Address - Country:US
Practice Address - Phone:310-798-8777
Practice Address - Fax:310-798-8783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29474111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty