Provider Demographics
NPI:1184708364
Name:COHEN, GERARD DOMINIQUE (DC)
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:DOMINIQUE
Last Name:COHEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 ALTA CANYADA RD
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2028
Mailing Address - Country:US
Mailing Address - Phone:818-790-5090
Mailing Address - Fax:818-790-5049
Practice Address - Street 1:238 SOUTH ARROYO PARKWAY, SUITE 140
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-4190
Practice Address - Country:US
Practice Address - Phone:626-449-9000
Practice Address - Fax:626-449-9939
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14344111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954174991OtherFEDERAL TAX I.D. NUMBER
CA954174991OtherFEDERAL TAX I.D. NUMBER