Provider Demographics
NPI:1710903927
Name:BIENENFELD, JOEL E (DC)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:E
Last Name:BIENENFELD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 CASTLE HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-1051
Mailing Address - Country:US
Mailing Address - Phone:310-993-6656
Mailing Address - Fax:818-348-1129
Practice Address - Street 1:2417 CASTLE HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-1051
Practice Address - Country:US
Practice Address - Phone:310-993-6656
Practice Address - Fax:818-348-1129
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15136111NS0005X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC15136Medicare PIN