Provider Demographics
NPI:1790901320
Name:GARBER, STUART H (DC, PHD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:H
Last Name:GARBER
Suffix:
Gender:M
Credentials:DC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 OCEAN FRONT WALK STE 11
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-2428
Mailing Address - Country:US
Mailing Address - Phone:310-458-3773
Mailing Address - Fax:
Practice Address - Street 1:1137 2ND ST STE 117
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5072
Practice Address - Country:US
Practice Address - Phone:310-458-3773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14603111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT17832Medicare UPIN