Provider Demographics
NPI:1902042427
Name:GITJARUNGERT, VANVISA (DC)
Entity Type:Individual
Prefix:DR
First Name:VANVISA
Middle Name:
Last Name:GITJARUNGERT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13746 VICTORY BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-6717
Mailing Address - Country:US
Mailing Address - Phone:818-359-6201
Mailing Address - Fax:818-475-1456
Practice Address - Street 1:13746 VICTORY BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-6717
Practice Address - Country:US
Practice Address - Phone:818-359-6201
Practice Address - Fax:818-475-1456
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31055111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
26-4347653OtherEIN
26-4347653OtherEIN