Provider Demographics
NPI:1740484294
Name:DR MICHAEL WARNER A PROFESSIONAL CHIROPRATIC CORPORATION
Entity type:Organization
Organization Name:DR MICHAEL WARNER A PROFESSIONAL CHIROPRATIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-340-0834
Mailing Address - Street 1:23161 VENTURA BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1105
Mailing Address - Country:US
Mailing Address - Phone:818-340-0834
Mailing Address - Fax:
Practice Address - Street 1:23161 VENTURA BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1105
Practice Address - Country:US
Practice Address - Phone:818-340-0834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 17906111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT18636Medicare UPIN
CADC17906Medicare ID - Type Unspecified