Provider Demographics
NPI:1952869661
Name:PELOFSKY SPORTS CHIROPRACTIC
Entity Type:Organization
Organization Name:PELOFSKY SPORTS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:PELOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-383-7360
Mailing Address - Street 1:700 WILSHIRE BLVD STE 510
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-3863
Mailing Address - Country:US
Mailing Address - Phone:310-383-7360
Mailing Address - Fax:213-415-1940
Practice Address - Street 1:700 WILSHIRE BLVD STE 510
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3863
Practice Address - Country:US
Practice Address - Phone:310-383-7360
Practice Address - Fax:213-415-1940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty