Provider Demographics
NPI:1205993474
Name:KOFMAN CHIROPRACTIC CORP
Entity type:Organization
Organization Name:KOFMAN CHIROPRACTIC CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-766-8485
Mailing Address - Street 1:11685 MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91601
Mailing Address - Country:US
Mailing Address - Phone:818-766-8485
Mailing Address - Fax:818-766-5591
Practice Address - Street 1:11685 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91601
Practice Address - Country:US
Practice Address - Phone:818-766-8485
Practice Address - Fax:818-766-5591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20670111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20670Medicare ID - Type Unspecified