Provider Demographics
NPI:1104229335
Name:ADVANCED CHIROPRACTIC & REHAB CENTER PATRICK KHAZIRAN DC INC
Entity type:Organization
Organization Name:ADVANCED CHIROPRACTIC & REHAB CENTER PATRICK KHAZIRAN DC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAZIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-986-1203
Mailing Address - Street 1:16200 VENTURA BLVD.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4633
Mailing Address - Country:US
Mailing Address - Phone:818-986-1203
Mailing Address - Fax:818-986-1282
Practice Address - Street 1:16200 VENTURA BLVD.
Practice Address - Street 2:SUITE 201
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4633
Practice Address - Country:US
Practice Address - Phone:818-986-1203
Practice Address - Fax:818-986-1282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty