Provider Demographics
NPI:1659497931
Name:EBERLY, DAWN NAOMI YOSHIOKA (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:NAOMI YOSHIOKA
Last Name:EBERLY
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:DR
Other - First Name:DAWN
Other - Middle Name:NAOMI
Other - Last Name:YOSHIOKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC, LAC
Mailing Address - Street 1:11901 SANTA MONICA BLVD
Mailing Address - Street 2:#377
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2767
Mailing Address - Country:US
Mailing Address - Phone:310-892-9495
Mailing Address - Fax:
Practice Address - Street 1:2001 S BARRINGTON AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5363
Practice Address - Country:US
Practice Address - Phone:424-273-1210
Practice Address - Fax:310-997-3530
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30522111NS0005X
CAAC 12570171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC 12570OtherACUPUNCTURIST
CADC30522OtherCHIROPRACTIC LICENSE