Provider Demographics
NPI:1518283233
Name:MICHAEL L. CLOSE CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:MICHAEL L. CLOSE CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CLOSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:323-656-4194
Mailing Address - Street 1:1042 N FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:W HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6103
Mailing Address - Country:US
Mailing Address - Phone:323-656-4194
Mailing Address - Fax:323-656-4151
Practice Address - Street 1:1042 N FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:W HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-6103
Practice Address - Country:US
Practice Address - Phone:323-656-4194
Practice Address - Fax:323-656-4151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26616111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC26616Medicare PIN