Reach out! We love to hear from our clients!
Share
Tweet
Share
Share
Call Now! (310-391-7770)
4329 Sepulveda Blvd Culver City, CA 90230
Call Now! 310-391-7770
(310) 391-7770
Home
About Us
OFFICE INFO
Map and Directions
Virtual Tour
Testimonials
Internet Specials
OFFICE HOURS
Monday 8:00am - 6:00pm
Tuesday 8:00am - 6:00pm
Wednesday 8:00am - 6:00pm
Thursday 8:00am - 5:00pm
Friday 8:00am - 4:00pm
Saturday 8:00am - 1:00pm
Sunday Closed
Services
Spinal Decompression
Digital X-Rays On Site
Specializing Treatments
What Is Sciatica?
Lower Back Pain Treatment
Techniques
Massage Therapy
Custom Foot Orthotics
FAQ
On-Line Appointments
New Patient Form
Existing Patient Form
Online Store
Standing Desks
Contact Us
Contact Our Billing Department
Please contact us for any questions on:
-Billing
-Receipts
-Medical Records
-Misc Request
-Insurance Questions
Please let us know the why you are contacting us so we can notify the proper staff.
*
Billing
Insurance Verification
Records Request
Misc: Please type specific request
Name:
First
Last
Email:
Phone:
Comments / Questions:
Medical Release Form
Upload Release Form for Medical Record Release
*
Max. file size: 200 MB.
If you are requesting medical records,
please download and sign this form
. You then upload a signed copy here when submitting your request.
Insurance Verification
Date of Birth
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Upload image of front of Insurance Card
*
Max. file size: 200 MB.
Upload image of back of Insurance Card
*
Max. file size: 200 MB.
Insurance Disclaimer
*
I have read and agree to the insurance coverage disclaimer.
When scheduling your appointment, please be advised that supplying us with your insurance information does not guarantee coverage. We do our best to have your coverage verified by the time you come in for your appointment, however please be advised that in the event we are unable to verify your coverage and/or need additional information, you are responsible for fees at the time of service. If you would like your insurance coverage verified and disclosed to you prior to coming in, please notify our office.
Please Confirm
