Provider Demographics
NPI:1881868255
Name:BIRD, JOEL WALTER (DC)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:WALTER
Last Name:BIRD
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 1:8036 3RD ST STE 103
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3674
Mailing Address - Country:US
Mailing Address - Phone:562-658-7956
Mailing Address - Fax:800-828-9183
Practice Address - Street 1:8036 3RD ST STE 103
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-3674
Practice Address - Country:US
Practice Address - Phone:562-658-7956
Practice Address - Fax:800-828-9183
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24994111N00000X, 111NI0013X, 111NN1001X, 111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
No111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA674292Medicare PIN