Provider Demographics
NPI:1831198076
Name:CHOATE, CLINTON J (LAC)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:J
Last Name:CHOATE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 COMSTOCK AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5014
Mailing Address - Country:US
Mailing Address - Phone:310-277-3567
Mailing Address - Fax:
Practice Address - Street 1:1851 COMSTOCK AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5014
Practice Address - Country:US
Practice Address - Phone:310-277-3567
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 3570171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist