Provider Demographics
NPI:1730703554
Name:TODD GEWANT D.C., CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:TODD GEWANT D.C., CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-258-0878
Mailing Address - Street 1:3200 SANTA MONICA BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2639
Mailing Address - Country:US
Mailing Address - Phone:310-453-4100
Mailing Address - Fax:310-453-4110
Practice Address - Street 1:3200 SANTA MONICA BLVD STE 205
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2639
Practice Address - Country:US
Practice Address - Phone:310-453-4100
Practice Address - Fax:310-453-4110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty