Provider Demographics
NPI:1194419762
Name:BEHMARDI KALANTARI, BABAK (DC)
Entity type:Individual
Prefix:DR
First Name:BABAK
Middle Name:
Last Name:BEHMARDI KALANTARI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4024 LOWDAN CT
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-7449
Mailing Address - Country:US
Mailing Address - Phone:714-936-1767
Mailing Address - Fax:
Practice Address - Street 1:11015 OLSON DR STE 6
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-5654
Practice Address - Country:US
Practice Address - Phone:916-635-7798
Practice Address - Fax:916-636-0344
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36434111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty