Provider Demographics
NPI:1508965013
Name:KILEY CHIROPRACTIC
Entity Type:Organization
Organization Name:KILEY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:KILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-371-4774
Mailing Address - Street 1:2850 ARTESIA BLVD
Mailing Address - Street 2:STE 207
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3419
Mailing Address - Country:US
Mailing Address - Phone:310-371-4774
Mailing Address - Fax:310-371-3453
Practice Address - Street 1:2850 ARTESIA BLVD
Practice Address - Street 2:STE 207
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3419
Practice Address - Country:US
Practice Address - Phone:310-371-4774
Practice Address - Fax:310-371-3453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU72112Medicare PIN