Provider Demographics
NPI:1902925886
Name:VONBORSTEL, EDWIN FREDERICK III (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:FREDERICK
Last Name:VONBORSTEL
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5220 CLARK AVE
Mailing Address - Street 2:SUITE445
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2618
Mailing Address - Country:US
Mailing Address - Phone:562-866-3340
Mailing Address - Fax:562-804-0499
Practice Address - Street 1:5220 CLARK AVE
Practice Address - Street 2:SUITE445
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2618
Practice Address - Country:US
Practice Address - Phone:562-866-3340
Practice Address - Fax:562-804-0499
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA15417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor