Provider Demographics
NPI:1386763126
Name:FARAHNAZ JALALI CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:FARAHNAZ JALALI CHIROPRACTIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARAHNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:JALALI
Authorized Official - Suffix:
Authorized Official - Credentials:DC, QME
Authorized Official - Phone:818-668-8136
Mailing Address - Street 1:19231 VICTORY BLVD
Mailing Address - Street 2:SUITE 556
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6308
Mailing Address - Country:US
Mailing Address - Phone:818-668-8136
Mailing Address - Fax:818-344-4349
Practice Address - Street 1:19231 VICTORY BLVD
Practice Address - Street 2:SUITE 556
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6308
Practice Address - Country:US
Practice Address - Phone:818-668-8136
Practice Address - Fax:818-344-4349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty