Provider Demographics
NPI:1902571821
Name:ERIC E GOFNUNG CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:ERIC E GOFNUNG CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOFNUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:323-933-2444
Mailing Address - Street 1:6221 WILSHIRE BLVD STE 604
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5215
Mailing Address - Country:US
Mailing Address - Phone:323-933-2444
Mailing Address - Fax:323-933-2909
Practice Address - Street 1:6221 WILSHIRE BLVD STE 604
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5215
Practice Address - Country:US
Practice Address - Phone:323-933-2444
Practice Address - Fax:323-933-2909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty