Provider Demographics
NPI:1285776914
Name:JAVANMARDI, NIKOO (DC)
Entity type:Individual
Prefix:
First Name:NIKOO
Middle Name:
Last Name:JAVANMARDI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 GRAND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-3639
Mailing Address - Country:US
Mailing Address - Phone:650-871-1364
Mailing Address - Fax:650-871-6612
Practice Address - Street 1:417 GRAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-3639
Practice Address - Country:US
Practice Address - Phone:650-871-1364
Practice Address - Fax:650-871-6612
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23186111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor