Provider Demographics
NPI:1801993969
Name:KLEINBRODT, BENJAMIN WOLFE (DC)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:WOLFE
Last Name:KLEINBRODT
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 1:11620 WILSHIRE BLVD
Mailing Address - Street 2:STE 710
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1781
Mailing Address - Country:US
Mailing Address - Phone:310-826-0721
Mailing Address - Fax:310-826-9894
Practice Address - Street 1:11620 WILSHIRE BLVD
Practice Address - Street 2:STE 710
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1781
Practice Address - Country:US
Practice Address - Phone:310-826-0721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27789111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU89280Medicare UPIN