Provider Demographics
NPI:1497835177
Name:CATALINA CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:CATALINA CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-378-7246
Mailing Address - Street 1:1919 S CATALINA AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5515
Mailing Address - Country:US
Mailing Address - Phone:310-378-7246
Mailing Address - Fax:310-373-9618
Practice Address - Street 1:1919 S CATALINA AVE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5515
Practice Address - Country:US
Practice Address - Phone:310-378-7246
Practice Address - Fax:310-373-9618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI25774Medicare UPIN
CAW14413Medicare ID - Type Unspecified