Provider Demographics
NPI:1316287642
Name:ALI, TABASSUM (DC)
Entity type:Individual
Prefix:DR
First Name:TABASSUM
Middle Name:
Last Name:ALI
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 1:234 6TH ST
Mailing Address - Street 2:APT 2
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6164
Mailing Address - Country:US
Mailing Address - Phone:972-693-2210
Mailing Address - Fax:
Practice Address - Street 1:4117 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1043
Practice Address - Country:US
Practice Address - Phone:714-734-8654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-23
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32556111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician