Provider Demographics
NPI:1134209240
Name:PTAK CHIROPRACTIC INC
Entity type:Organization
Organization Name:PTAK CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:PTAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-473-7991
Mailing Address - Street 1:11545 WEST OLYMPIC BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064
Mailing Address - Country:US
Mailing Address - Phone:310-473-7991
Mailing Address - Fax:310-473-7921
Practice Address - Street 1:11545 WEST OLYMPIC BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064
Practice Address - Country:US
Practice Address - Phone:310-473-7991
Practice Address - Fax:310-473-7921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC17586AMedicare PIN
T18571Medicare UPIN