Provider Demographics
NPI:1720280142
Name:LAWNDALE CHIROPRACTIC & PHYSICAL THERAPY GROUP
Entity Type:Organization
Organization Name:LAWNDALE CHIROPRACTIC & PHYSICAL THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARMIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-219-0890
Mailing Address - Street 1:14516 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1519
Mailing Address - Country:US
Mailing Address - Phone:310-219-0890
Mailing Address - Fax:310-219-0297
Practice Address - Street 1:14516 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1519
Practice Address - Country:US
Practice Address - Phone:310-219-0890
Practice Address - Fax:310-219-0297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27287261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC27287AMedicare ID - Type UnspecifiedMEDICARE ID#