Provider Demographics
NPI:1760502637
Name:GERARD D. & EDITH T. COHEN
Entity Type:Organization
Organization Name:GERARD D. & EDITH T. COHEN
Other - Org Name:COHEN CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:DOMINIQUE
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:626-449-9000
Mailing Address - Street 1:4550 ALTA CANYADA RD
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2028
Mailing Address - Country:US
Mailing Address - Phone:818-790-5090
Mailing Address - Fax:818-790-5049
Practice Address - Street 1:238 SOUTH ARROYO PARKWAY, SUITE 140
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-4190
Practice Address - Country:US
Practice Address - Phone:626-449-9000
Practice Address - Fax:626-449-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14344111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC14344AMedicare UPIN
CADC14344AMedicare ID - Type Unspecified