NPIMap

Organization Active NPI

Moon Chiropractic Group, Inc

  • Rehabilitation Chiropractor
  • Los Angeles, CA
National Provider Identifier
1952667065
Registry record updated Apr 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation ChiropractorTaxonomy code 111NR0400X
License
29321 Issued in CA
Legal business name
MOON CHIROPRACTIC GROUP, INC
Practice address
2560 W Olympic Blvd
Ste 304
Los Angeles, CA 90006-2972
Phone
(213) 388-9994
NPI assigned
Apr 3, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jimmy J Bae, D.C.NPI 1780659326
Title
Cfo
Phone
(213) 388-9994

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NR0400X 29321 CA Primary

Addresses

Primary practice location

2560 W Olympic Blvd
Ste 304
Los Angeles, CA 90006-2972

Mailing address

2560 W Olympic Blvd
Ste 304
Los Angeles, CA 90006-2972

National Provider Directory

National Provider Directory

Locations

2560 W Olympic Blvd
#304
Los Angeles, CA 90006
Phone (213) 388-9994

2560 W Olympic Blvd
Ste 304
Los Angeles, CA 90006
Phone (213) 256-4239

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1333411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333411200000",
    "number": "1952667065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2560 W OLYMPIC BLVD",
            "address_2": "STE 304",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900062972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2560 W OLYMPIC BLVD",
            "address_2": "STE 304",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900062972",
            "telephone_number": "213-388-9994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOON CHIROPRACTIC GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-03",
        "last_updated": "2012-04-03",
        "status": "A",
        "authorized_official_last_name": "BAE",
        "authorized_official_first_name": "JIMMY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "213-388-9994",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": "CA",
            "license": "29321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.