Provider Demographics
NPI:1174085773
Name:CO, JOEY
Entity type:Individual
Prefix:
First Name:JOEY
Middle Name:
Last Name:CO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 E OLIVE AVE STE F
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1250
Mailing Address - Country:US
Mailing Address - Phone:818-953-7150
Mailing Address - Fax:818-953-7145
Practice Address - Street 1:348 E OLIVE AVE STE F
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1250
Practice Address - Country:US
Practice Address - Phone:818-953-7150
Practice Address - Fax:818-953-7145
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty