Provider Demographics
NPI:1316141021
Name:TCHOBANIAN, GARY (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:TCHOBANIAN
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 1:2950 LOS FELIZ BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-1532
Mailing Address - Country:US
Mailing Address - Phone:323-663-6664
Mailing Address - Fax:323-663-6695
Practice Address - Street 1:2950 LOS FELIZ BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-1532
Practice Address - Country:US
Practice Address - Phone:323-663-6664
Practice Address - Fax:323-663-6695
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25187111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17873Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER