Provider Demographics
NPI:1841222486
Name:DR CHERYL REVKIN DC, INC.
Entity Type:Organization
Organization Name:DR CHERYL REVKIN DC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LESLEE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PAINTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-665-1281
Mailing Address - Street 1:1724 WEST SILVERLAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026
Mailing Address - Country:US
Mailing Address - Phone:323-665-1281
Mailing Address - Fax:323-665-2739
Practice Address - Street 1:1724 WEST SILVERLAKE DRIVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026
Practice Address - Country:US
Practice Address - Phone:323-665-1281
Practice Address - Fax:323-665-2739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11799111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1598739872OtherNPI INDIVIDUAL TYPE 1
CA1598739872OtherNPI INDIVIDUAL TYPE 1