Provider Demographics
NPI:1578821229
Name:ALTERNATIVE PAIN MANAGEMENT CLINIC
Entity Type:Organization
Organization Name:ALTERNATIVE PAIN MANAGEMENT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REUBEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAKKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-537-3467
Mailing Address - Street 1:500 E COMPTON BLVD
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-3209
Mailing Address - Country:US
Mailing Address - Phone:310-537-3467
Mailing Address - Fax:310-537-1966
Practice Address - Street 1:500 E COMPTON BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-3209
Practice Address - Country:US
Practice Address - Phone:310-537-3467
Practice Address - Fax:310-537-1966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16997111N00000X
111NI0013X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty