Provider Demographics
NPI:1790902385
Name:BITEW, THEODORE (DC)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:
Last Name:BITEW
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 1:9800 S LA CIENEGA BLVD
Mailing Address - Street 2:SUITE 200-41
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4440
Mailing Address - Country:US
Mailing Address - Phone:323-782-0541
Mailing Address - Fax:
Practice Address - Street 1:9800 S LA CIENEGA BLVD
Practice Address - Street 2:SUITE 200-41
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4440
Practice Address - Country:US
Practice Address - Phone:323-782-0541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29790111N00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7068Medicaid
CA7420Medicaid