Provider Demographics
NPI:1972627461
Name:JORGE ARVIZU, DC AND MARTIN STITES, DC CHIROPRACTIC CORP
Entity Type:Organization
Organization Name:JORGE ARVIZU, DC AND MARTIN STITES, DC CHIROPRACTIC CORP
Other - Org Name:TRIAD WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STITES
Authorized Official - Suffix:
Authorized Official - Credentials:DC, OTR
Authorized Official - Phone:818-285-4242
Mailing Address - Street 1:14622 VENTURA BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3664
Mailing Address - Country:US
Mailing Address - Phone:818-285-4242
Mailing Address - Fax:818-285-4244
Practice Address - Street 1:14622 VENTURA BLVD STE 205
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3664
Practice Address - Country:US
Practice Address - Phone:818-285-4242
Practice Address - Fax:818-285-4244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17077Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER I