Provider Demographics
NPI:1538285531
Name:CHURCHILL, DANA (ND)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:
Last Name:CHURCHILL
Suffix:
Gender:M
Credentials:ND
Other - Prefix:DR
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:CHURCHILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:11704 WILSHIRE BLVD
Mailing Address - Street 2:D202
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1507
Mailing Address - Country:US
Mailing Address - Phone:310-230-5228
Mailing Address - Fax:310-526-7501
Practice Address - Street 1:11704 WILSHIRE BLVD
Practice Address - Street 2:D202
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1507
Practice Address - Country:US
Practice Address - Phone:310-230-5228
Practice Address - Fax:310-526-7501
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND173175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath