Provider Demographics
NPI:1639404023
Name:GATEWAY CHIROPRACTIC GROUP
Entity Type:Organization
Organization Name:GATEWAY CHIROPRACTIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:HOMAYOUN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HAMIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-863-6196
Mailing Address - Street 1:2677 ZOE AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4195
Mailing Address - Country:US
Mailing Address - Phone:323-583-0014
Mailing Address - Fax:323-583-8843
Practice Address - Street 1:2677 ZOE AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4195
Practice Address - Country:US
Practice Address - Phone:323-583-0014
Practice Address - Fax:323-583-8843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty