Provider Demographics
NPI:1912560426
Name:DR. TRACEY A BLEAHU CHIROPRACTIC INC
Entity Type:Organization
Organization Name:DR. TRACEY A BLEAHU CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DESIGNATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MARIA SOLITA
Authorized Official - Middle Name:ANGELES
Authorized Official - Last Name:BERNARDINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-301-8762
Mailing Address - Street 1:20501 VENTURA BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2393
Mailing Address - Country:US
Mailing Address - Phone:818-301-8762
Mailing Address - Fax:
Practice Address - Street 1:20501 VENTURA BLVD STE 102
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2393
Practice Address - Country:US
Practice Address - Phone:818-301-8762
Practice Address - Fax:818-301-8763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-19
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty