Provider Demographics
NPI:1679713911
Name:CHIROPRACTIC CARE CENTER INC.
Entity Type:Organization
Organization Name:CHIROPRACTIC CARE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:PAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:213-627-0287
Mailing Address - Street 1:112 W 9TH ST
Mailing Address - Street 2:SUITE 1126
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-1510
Mailing Address - Country:US
Mailing Address - Phone:213-627-0287
Mailing Address - Fax:213-627-8428
Practice Address - Street 1:112 W 9TH ST
Practice Address - Street 2:SUITE 1126
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-1510
Practice Address - Country:US
Practice Address - Phone:213-627-0287
Practice Address - Fax:213-627-8428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-30410305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization