Provider Demographics
NPI:1356512636
Name:CORPORATE SPINAL WELLNESS SYSTEMS
Entity type:Organization
Organization Name:CORPORATE SPINAL WELLNESS SYSTEMS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:HAYES
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-447-5131
Mailing Address - Street 1:5042 WILSHIRE BLVD.
Mailing Address - Street 2:NO. 222
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4305
Mailing Address - Country:US
Mailing Address - Phone:310-447-5131
Mailing Address - Fax:323-932-0886
Practice Address - Street 1:5042 WILSHIRE BLVD
Practice Address - Street 2:NO. 222
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4305
Practice Address - Country:US
Practice Address - Phone:310-447-5131
Practice Address - Fax:323-932-0886
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORPORATE SPINAL WELLNESS SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-14
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29699111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB901AMedicare UPIN