Provider Demographics
NPI:1558092486
Name:DR. DEREK LEVY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:DR. DEREK LEVY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:V
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-379-0503
Mailing Address - Street 1:950 AVIATION BLVD STE K
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-4016
Mailing Address - Country:US
Mailing Address - Phone:310-379-0503
Mailing Address - Fax:310-379-9631
Practice Address - Street 1:950 AVIATION BLVD STE K
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-4016
Practice Address - Country:US
Practice Address - Phone:310-379-0503
Practice Address - Fax:310-379-9631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-21
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
543488310OtherAETNA
1285659318OtherNPPES
50186OtherAMERICAN SPECIALTY HEALTH