Provider Demographics
NPI:1396778031
Name:COLE, DOUGLAS (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:COLE
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 1:12930 VENTURA BLVD
Mailing Address - Street 2:SUITE 226-C
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2200
Mailing Address - Country:US
Mailing Address - Phone:818-995-4472
Mailing Address - Fax:
Practice Address - Street 1:12930 VENTURA BLVD
Practice Address - Street 2:SUITE 226-C
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2200
Practice Address - Country:US
Practice Address - Phone:818-995-4472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21656111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC21656Medicare ID - Type Unspecified