Provider Demographics
NPI:1700057924
Name:JIMMY BAE CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:JIMMY BAE CHIROPRACTIC CORPORATION
Other - Org Name:HARVARD LA CHIROPRACTIC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:213-382-0560
Mailing Address - Street 1:266 S HARVARD BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-4372
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:266 S HARVARD BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-4372
Practice Address - Country:US
Practice Address - Phone:213-382-0560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-15
Last Update Date:2008-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty