Provider Demographics
NPI:1598807174
Name:TREPANY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:TREPANY CHIROPRACTIC INC
Other - Org Name:DONALD A TREPANY DC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:TREPANY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-301-4204
Mailing Address - Street 1:13202 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066
Mailing Address - Country:US
Mailing Address - Phone:310-301-4204
Mailing Address - Fax:310-301-4303
Practice Address - Street 1:13202 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045
Practice Address - Country:US
Practice Address - Phone:310-301-4204
Practice Address - Fax:310-301-4303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0021149Medicare ID - Type Unspecified