Provider Demographics
NPI:1811281884
Name:WHITTIER SPINE CENTER INC
Entity type:Organization
Organization Name:WHITTIER SPINE CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEILAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:562-902-9292
Mailing Address - Street 1:16214 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2901
Mailing Address - Country:US
Mailing Address - Phone:562-902-9292
Mailing Address - Fax:562-315-5266
Practice Address - Street 1:16214 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2901
Practice Address - Country:US
Practice Address - Phone:562-902-9292
Practice Address - Fax:562-315-5266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51161207Q00000X
CAG0728152081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6621640001Medicare NSC