Provider Demographics
NPI:1629278395
Name:KOMBERG, EDWARD (DC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:KOMBERG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7951 VALLEY VIEW ST
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1848
Mailing Address - Country:US
Mailing Address - Phone:714-994-1131
Mailing Address - Fax:714-994-0130
Practice Address - Street 1:7951 VALLEY VIEW ST
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1848
Practice Address - Country:US
Practice Address - Phone:714-994-1131
Practice Address - Fax:714-994-0130
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor