Provider Demographics
NPI:1255520185
Name:CAL SPORTS HEALTH CENTER
Entity type:Organization
Organization Name:CAL SPORTS HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SVERDLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-558-9328
Mailing Address - Street 1:PO BOX 35484
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-0484
Mailing Address - Country:US
Mailing Address - Phone:310-558-9328
Mailing Address - Fax:310-558-9316
Practice Address - Street 1:1833 S LA CIENEGA BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-4662
Practice Address - Country:US
Practice Address - Phone:310-558-9328
Practice Address - Fax:310-558-9316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26250111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC26250OtherLICENSE #