Provider Demographics
NPI:1659494656
Name:ABC HEALTHCARE INC
Entity Type:Organization
Organization Name:ABC HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-652-3200
Mailing Address - Street 1:333 WASHINGTON BLVD
Mailing Address - Street 2:#419
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5152
Mailing Address - Country:US
Mailing Address - Phone:310-652-3200
Mailing Address - Fax:
Practice Address - Street 1:8730 SANTA MONICA BLVD STE E
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-4547
Practice Address - Country:US
Practice Address - Phone:310-652-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24091111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty