Provider Demographics
NPI:1699031393
Name:DANA LARIDAEN CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:DANA LARIDAEN CHIROPRACTIC INC.
Other - Org Name:O2 CHIROPRACTIC AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LARIDAEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-392-3929
Mailing Address - Street 1:2817 OCEAN PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2905
Mailing Address - Country:US
Mailing Address - Phone:310-392-3929
Mailing Address - Fax:
Practice Address - Street 1:2817 OCEAN PARK BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-2905
Practice Address - Country:US
Practice Address - Phone:310-392-3929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-30839111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty