Provider Demographics
NPI:1538479100
Name:BIRD CHIROPRACTIC CLINICS
Entity Type:Organization
Organization Name:BIRD CHIROPRACTIC CLINICS
Other - Org Name:ADVANCED WELLNESS & CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:562-658-7956
Mailing Address - Street 1:8036 3RD, ST.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241
Mailing Address - Country:US
Mailing Address - Phone:562-658-7956
Mailing Address - Fax:800-828-9183
Practice Address - Street 1:8036 3RD, ST.
Practice Address - Street 2:SUITE 103
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241
Practice Address - Country:US
Practice Address - Phone:562-658-7956
Practice Address - Fax:800-828-9183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24994111N00000X, 111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC24994OtherMEDICARE PTAN
CADC24994OtherMEDICARE PTAN