Basic Information
| Provider Information | |||||||||
| NPI: | 1255472221 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BVC THERAPY GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16377 LAS CUMBRES DR | ||||||||
| Address2: | |||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906031139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629439559 | ||||||||
| FaxNumber: | 5629437518 | ||||||||
| Practice Location | |||||||||
| Address1: | 6301 BEACH BLVD STE 109 | ||||||||
| Address2: | |||||||||
| City: | BUENA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906214030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146754817 | ||||||||
| FaxNumber: | 7149948090 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2007 | ||||||||
| LastUpdateDate: | 09/04/2022 | ||||||||
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| AuthorizedOfficialLastName: | CHANG | ||||||||
| AuthorizedOfficialFirstName: | HUBERT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 7146754817 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
| NPICertificationDate: | 09/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | DC25672 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | 225X00000X | OT1465 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | PT17004 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | ZZZ66234Z | 01 | CA | HC BLUE CROSS BLUE SHIELD | OTHER | ZZZ66235Z | 01 | CA | FV BLUE CROSS BLUE SHIELD | OTHER | ZZZ66236Z | 01 | CA | PB BLUE CROSS BLUE SHIELD | OTHER |