Provider Demographics
NPI:1659381457
Name:DOUGLAS COLE CHIROPRACTIC INC
Entity Type:Organization
Organization Name:DOUGLAS COLE CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-995-4472
Mailing Address - Street 1:12930 VENTURA BLVD
Mailing Address - Street 2:SUITE 226C
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2200
Mailing Address - Country:US
Mailing Address - Phone:818-995-4472
Mailing Address - Fax:
Practice Address - Street 1:12930 VENTURA BLVD
Practice Address - Street 2:SUITE 226C
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2200
Practice Address - Country:US
Practice Address - Phone:818-995-4472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21656111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC21656Medicare ID - Type Unspecified