Provider Demographics
NPI:1629123559
Name:PARK CENTER FOR HEALTH
Entity Type:Organization
Organization Name:PARK CENTER FOR HEALTH
Other - Org Name:PARK CENTER - EAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:F
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-222-5636
Mailing Address - Street 1:PO BOX 8188
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91372-8188
Mailing Address - Country:US
Mailing Address - Phone:818-222-5636
Mailing Address - Fax:818-222-8853
Practice Address - Street 1:22471 SUENO RD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2900
Practice Address - Country:US
Practice Address - Phone:818-222-5636
Practice Address - Fax:818-222-8853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14679111NN1001X, 111NR0400X
CADC25493111NN1001X, 111NR0400X
CADC15677111NS0005X
CAAC5637171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty